Comparison of Intra-Operative ECG Variations (QRS and PR Interval Prolongation) Between 0.25% Ropivacaine and 0.25% Bupivacaine in Patients Undergoing Lower Limb Surgery under Epidural Blockade

Title: Comparison of Intra-Operative ECG Variations (QRS and PR Interval Prolongation) Between 0.25% Ropivacaine and 0.25% Bupivacaine in Patients Undergoing Lower Limb Surgery under Epidural Blockade

Authors: Dr A K Sinha, Dr D C Punera, Dr U palaria, Dr Mehar Bano, Dr Sagufta Ansari

DOI: http://dx.doi.org/10.18535/jmscr/v4i8.75

Abstract

Background: Ropivacaine, new aminoamide local anaesthetic (LA) drug, is chemically homologous to bupivacaine. The lower lipid solubility and higher clearance of ropivacaine compared with bupivacaine is presumed to retard penetration of myelin sheaths, leading to a decreased potential for neural and cardiac toxicity. This may offer an advantage in terms of systemic toxicity. Experimental studies and case reports confirm this hypothesis, showing that ropivacaine causes fewer cardiotoxic effects and is better alternative to bupivcaine.

Material & Method: Thirty ASA grade I and II patients of either sex, aged between 20 -50 years undergoing elective lower limb surgeries were enrolled in each group using double-blind randomization. Each group received 0.25%, 25 ml of either bupivacaine or ropivacaine with 18 G needle as single shot epidural injection. A sensory level of T₁₀ was achieved. Variations in heart rate, arterial blood pressure and ECG (P-R interval & QRS prolongation, ectopics, arrhythmias) were recorded before epidural injection, 10 minutes after epidural injection and thereafter every 10 minutes interval till the end of surgery.

Result: This study showed that epidural ropivacaine produced ECG changes which were substantially similar to those produced by equipotent concentrations and doses of bupivacaine.

Conclusion: ECG changes in terms of ventricular arrhythmias, QRS and P-R interval were clinically similar in both groups.

Keywords: Epidural anaesthesia, cardiotoxicity, bupivacaine, ropivacaine

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Corresponding Author

Dr Urmila Palaria

Professor, Anaesthesiology & Critical Care

GMC, Haladwani

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