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
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 1. Gaurav Kuthiala ,Geeta Chaudhary. Ropivacaine: A review of its pharmacology and clinical use. Indian J Anaesth. 2011 Mar-Apr; 55(2): 104–110. 2. Michael J. Cousins, Phillip O. Bridenbaugh .Neural Blockade in Clinical Anesthesia and Management of Pain. 1998, Lippincot-Raven Publisher.Volume 494 3. J.H. McCLURE. Ropivacaine. British Journal of Anaesthesia.1996;76:300-307 4. J. B. Whiteside and J. A. W. Wildsmith. Developments in local anaesthetic drugs. Br J Anaesth 2001; 87: 27–35 5. Mantouvalou, S Ralli, H Arnaoutoglou, G Tziris, G Papadopoulos. Epidurall anesthesia: Comparison of plain ropivacaine, bupivacaine and levobupivacaine for lower abdominal surgery. Acta Anaesth. Belg. 2008; 59:65-71 6. K T Ebrahim , Charles Thomas , Maya Rose , Sanjana Vinod , Ali Akbar Shafi. Comparison of Onset and Duration of Sensory and Motor Blockade with Ropivacaine 0.75% and Bupivacaine 0.5% in Epidural Anaesthesia - A Clinical Trial IOSR Journal of Dental and Medical Sciences (IOSR-JDMS).Volume 15, (1) Ver. VII ( 2016), Pg 60-64 7. Reiz S, Nath S. Cardiotoxicity of local anaesthetic agents. Br J Anaesthesia.1986.58:736-746 8. B Cox, M E Durieux and M A E Marcus. Toxicity of Local Anaesthetics. Best Practice & Research Clinical Anaesthesiology.2003.17(1):111-136 9. Clarkson C et al. Mechanism for bupivacaine depression of cardiac conduction: fastblock of sodium channels during the action potential with slow recovery from block during diastole. Anaesthesiology 1985. 62:396-405 10. Adam Brooks, Keith Girling, Bernaed Riley, Brian Rowlands.Critical Care for Postgraduates Trainees. Edward Arnold (Publisher) Ltd. 2005.Pg 154 11. Feldman HS, Dvoskin S, Halldin MH, Ask AL, Doucette AM. Comparative local anesthetic efficacy and pharmacokinetics of epidurally administered ropivacaine and bupivacaine in the sheep. Reg Anesth. 1997 Sep-Oct;22(5):451-60. 12. Teena Bansal, Sarla Hood.Ropivacaine-A novel and promising local anaesthetic drug. Asian J Pharm Clin Res.2012. Vol 5 Suppl 1:13-15 13. Arlock P. Actions of three local anaesthetic drugs: lidocaine bupivacaine and ropivacaine on guinea pig papillary muscle sodium channels V (max). Pharmacol Toxicol 1988; 63: 96-104 14. Vanhoutte F, Vereecke J et al. Effects of enantiomers of bupivacaine on the electrophysiological properties of the guinea-pig papillary muscle.Br J of Pharmacology. 1991.103:1275-1281 15. Capogna G, Celleno D, Fusco P, Lyons G, Columb M. Relative potencies of bupivacaine and ropivacaine for analgesia in labour. Br J Anaesth 1999; 82: 371–3 16. Polley LS, Columb MO, Naughton NN, Wagner DS, Cosmas JM. Relative analgesic potencies of ropivacaine and bupivacaine for epidural analgesia in labour. Anesthesiology 1999; 90 944–50 17. Arthur GR, Wildsmith JAW, Tucker GT. Pharmacology of local anaesthetic drugs. In: Wildsmith JAW, Armitage EN, eds. Principles and practice of regional anaesthesia. London: Churchill Livingstone, 1993:29-45.Abstract
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