Myocardial contractility impairment with racemic bupivacaine, non-racemic bupivacaine and ropivacaine. A comparative study.

PURPOSE To study racemic bupivacaine, non-racemic bupivacaine and ropivacaine on myocardial contractility. METHODS Isolated Wistar papillary muscles were submitted to 50 and 100 mM racemic bupivacaine (B50 and B100), non-racemic bupivacaine (NR50 and NR100) and ropivacaine (R50 and R100) intoxication. Isometric contraction data were obtained in basal condition (0.2 Hz), after increasing the frequency of stimulation to 1.0 Hz and after 5, 10 and 15 min of local anesthetic intoxication. Data were analyzed as relative changes of variation. RESULTS Developed tension was higher with R100 than B100 at D1 (4.3 ± 41.1 vs -57.9 ± 48.1). Resting tension was altered with B50 (-10.6 ± 23.8 vs -4.7 ± 5.0) and R50 (-14.0 ± 20.5 vs -0.5 ± 7.1) between D1 and D3. Maximum rate of tension development was lower with B100 (-56.6 ± 38.0) than R50 (-6.3 ± 37.9) and R100 (-1.9 ± 37.2) in D1. B50, B100 and NR100 modified the maximum rate of tension decline from D1 through D2. Time to peak tension was changed with NR50 between D1 and D2. CONCLUSIONS Racemic bupivacaine depressed myocardial contractile force more than non-racemic bupivacaine and ropivacaine. Non-racemic and racemic bupivacaine caused myocardial relaxation impairment more than ropivacaine.

[1]  A. Deussen,et al.  Myocardial Accumulation of Bupivacaine and Ropivacaine Is Associated with Reversible Effects on Mitochondria and Reduced Myocardial Function , 2013, Anesthesia and analgesia.

[2]  H. Tsuchiya,et al.  R(+)-, Rac-, and S(–)-Bupivacaine Stereostructure-Specifically Interact with Membrane Lipids at Cardiotoxically Relevant Concentrations , 2012, Anesthesia and analgesia.

[3]  G. Szabó,et al.  Effects of articaine and ropivacaine on calcium handling and contractility in canine ventricular myocardium , 2010, European journal of anaesthesiology.

[4]  J. Butterworth.  Models and Mechanisms of Local Anesthetic Cardiac Toxicity: A Review , 2009, Regional Anesthesia & Pain Medicine.

[5]  O. Eve,et al.  Effects of bupivacaine, levobupivacaine and ropivacaine on myocardial relaxation , 2007, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[6]  J. Amour,et al.  Comparison of the effects of mepivacaine and lidocaine on rat myocardium , 2007, European journal of anaesthesiology.

[7]  A. Deussen,et al.  The Effects of Lipid Infusion on Myocardial Function and Bioenergetics in l-Bupivacaine Toxicity in the Isolated Rat Heart , 2007, Anesthesia and analgesia.

[8]  M. M. Trachez,et al.  Regulation of Intracellular Calcium by Bupivacaine Isomers in Cardiac Myocytes from Wistar Rats , 2006, Anesthesia and analgesia.

[9]  M. M. Trachez,et al.  Motor nerve blockade potency and toxicity of non‐racemic bupivacaine in rats , 2005, Acta anaesthesiologica Scandinavica.

[10]  Y. Tanifuji,et al.  Comparative Effects of Bupivacaine and Ropivacaine on Intracellular Calcium Transients and Tension in Ferret Ventricular Muscle , 2004, Anesthesiology.

[11]  Y. Nakaya,et al.  Molecular Mechanisms of the Inhibitory Effects of Bupivacaine, Levobupivacaine, and Ropivacaine on Sarcolemmal Adenosine Triphosphate–sensitive Potassium Channels in the Cardiovascular System , 2004, Anesthesiology.

[12]  M. Mulroy.  Systemic Toxicity and Cardiotoxicity From Local Anesthetics: Incidence and Preventive Measures , 2002, Regional Anesthesia & Pain Medicine.

[13]  Y. Tanifuji,et al.  Bupivacaine Attenuates Contractility by Decreasing Sensitivity of Myofilaments to Ca2+, in Rat Ventricular Muscle , 2002, Anesthesiology.

[14]  B. Graf,et al.  Differences in Cardiotoxicity of Bupivacaine and Ropivacaine Are the Result of Physicochemical and Stereoselective Properties , 2002, Anesthesiology.

[15]  L. Groban,et al.  Differences in cardiac toxicity among ropivacaine, levobupivacaine, bupivacaine, and lidocaine * , 2001 .

[16]  T. Nelson,et al.  Is Comparative Cardiotoxicity of S(−) and R(+) Bupivacaine Related to Enantiomer-Selective Inhibition of L-Type Ca2+ Channels? , 2001, Anesthesia and analgesia.

[17]  G. Strichartz,et al.  Block of Human Heart hH1 Sodium Channels by the Enantiomers of Bupivacaine , 2000, Anesthesiology.

[18]  G. Strichartz,et al.  Potency of bupivacaine stereoisomers tested in vitro and in vivo: biochemical, electrophysiological, and neurobehavioral studies. , 2000, Anesthesiology.

[19]  P. Frascarolo,et al.  A Comparison of the Electrocardiographic Cardiotoxic Effects of Racemic Bupivacaine, Levobupivacaine, and Ropivacaine in Anesthetized Swine , 2000, Anesthesia and analgesia.

[20]  G. Edelman,et al.  Bupivacaine Inhibits Acylcarnitine Exchange in Cardiac Mitochondria , 2000, Anesthesiology.

[21]  J. Tamargo,et al.  Stereoselective block of cardiac sodium channels by bupivacaine in guinea pig ventricular myocytes. , 1995, Circulation.

[22]  G A Albright,et al.  Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. , 1979, Anesthesiology.