British Journal of Anaesthesia, Vol 78, Issue 5 507-514, Copyright © 1997 by The Board of Management and Trustees of the British Journal of Anaesthesia
K. Knudsen, M. B. Suurkula, S. Blomberg, J. Sjovall and N. Edvardsson
We have compared the incidence of CNS symptoms and changes in
echocardiography and electrophysiology during i.v. infusions of
ropivacaine, bupivacaine and placebo. Acute tolerance of i.v. infusion of
10 mg min-1 was studied in a crossover, randomized, double-blind study in
12 volunteers previously acquainted with the CNS effects of lignocaine. The
maximum tolerated dose for CNS symptoms was higher after ropivacaine in
nine of 12 subjects and higher after bupivacaine in three subjects. The 95%
confidence limits for the difference in mean dose between ropivacaine and
bupivacaine were -30 and 7 mg. The maximum tolerated unbound arterial
plasma concentration was twice as high after ropivacaine (P < 0.001).
Muscular twitching occurred more frequently after bupivacaine (P <
0.05). The time to disappearance of all symptoms was shorter after
ropivacaine (P < 0.05). A threshold for CNS toxicity was apparent at a
mean free plasma concentration of approximately 0.6 mg litre-1 for
ropivacaine and 0.3 mg litre-1 for bupivacaine. Bupivacaine increased QRS
width during sinus rhythm compared with placebo (P < 0.001) and
ropivacaine (P < 0.01). Bupivacaine reduced both left ventricular
systolic and diastolic function compared with placebo (P < 0.05 and P
< 0.01, respectively), while ropivacaine reduced only systolic function
(P < 0.01).
CLINICAL INVESTIGATIONS
Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers
Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital, S-413 45 Goteborg; Department of Clinical Physiology, Sahlgrenska University Hospital, S-413 45 Goteborg; Division of Cardiology, Sahlgrenska University Hospital, S-413 45 Goteborg; Clinical Research and Development, Astra Pain Control AB, S-151 85 Sodertalje, Sweden
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