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REGIONAL ANESTHESIA

The Comparative Electrophysiologic and Hemodynamic Effects of a Large Dose of Ropivacaine and Bupivacaine in Anesthetized and Ventilated Piglets

Jean-Yves Lefrant, MD PhD^*, Jean E. de La Coussaye, MD PhD^*, Jacques Ripart, MD PhD^*, Laurent Muller, MD MSc^*, Laurent Lalourcey, MD MSc^*, Pascale A. Peray, MD PhD, X. Mazoit, MD PhD, Antoine Sassine, MD, and Jean-Jacques Eledjam, MD^*

Departments of *Anesthesiology, Critical Care, and Emergency, and the Department of Epidemiology and Biostatistics, University-Hospital of Nîmes, France; Laboratoire d’Anesthésie, UPRES EA 392, Faculté de Médecine, Université Paris Sud, Kremlin Bicêtre, Bicêtre, France; and the Laboratory of Anesthesiology and Cardiovascular Physiology, Medical School of Montpellier-Nîmes, France

Address correspondence and reprint requests to Professeur Jean E. de La Coussaye, Département d’Urgences-Réanimation, CHU Nîmes, 5 Rue Hoche, 30029 Nîmes, Cedex 4, France.

Ropivacaine is less potent and less toxic than bupivacaine. We administered these two local anesthetics in a cardiac electrophysiologic model of sodium thiopental-anesthetized and ventilated piglets. After assessing the stability of the model, bupivacaine (4 mg/kg) and ropivacaine (6 mg/kg) were given IV in two groups (n = 7) of piglets. No alteration in biological variables was reported throughout the study. Bupivacaine and ropivacaine similarly decreased mean aortic pressure from 99 ± 22 to 49 ± 31 mm Hg and from 87 ± 17 to 58 ± 28 mm Hg, respectively, and decreased the peak of the first derivative of left ventricular pressure from 1979 ± 95 to 689 ± 482 mm Hg/s and from 1963 ± 92 to 744 ± 403 mm Hg/s, respectively. Left ventricular end-diastolic pressure was similarly increased from 6 ± 5 to 9 ± 5 mm Hg and from 6 ± 4 to 12 ± 4 mm Hg, respectively. Bupivacaine and ropivacaine similarly lengthened the cardiac cycle length (R-R; from 479 ± 139 to 706 ± 228 ms and from 451 ± 87 to 666 ± 194 ms, respectively), atria His (from 71 ± 15 to 113 ± 53 ms and from 64 ± 6 to 86 ± 10 ms, respectively), and QTc (QTc = QT x R-R^-0.5, Bazett formula; from 380 ± 71 to 502 ± 86 ms and from 361 ± 33 to 440 ± 56 ms, respectively) intervals. Bupivacaine altered to a greater extent the PQ (the onset of the P wave to the Q wave of the QRS complex) (from 97 ± 20 to 211 ± 60 ms versus from 91 ± 8 to 145 ± 38 ms, P < 0.05), QRS (from 58 ± 3 to 149 ± 34 ms versus from 60 ± 5 to 101 ± 17 ms, P < 0.05), and His ventricle interval (from 25 ± 4 to 105 ± 30 ms vs from 25 ± 4 to 60 ± 30 ms, P < 0.05) than ropivacaine. A 6 mg/kg ropivacaine dose induced similar hemodynamic alterations as 4 mg/kg bupivacaine. However, bupivacaine altered the variables of ventricular conduction (QRS and His ventricle) to a greater extent.

IMPLICATIONS: A 6 mg/kg ropivacaine dose induced similar hemodynamic alterations as 4 mg/kg bupivacaine. However, bupivacaine altered the variables of ventricular conduction (QRS and His ventricle) to a greater extent.

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