Korean J Anesthesiol.  2001 Mar;40(3):365-375. 10.4097/kjae.2001.40.3.365.

Interaction between Bupivacaine, Ropivacaine and Diltiazem in the Isolated Rat Heart

• Lee YM
• Lim SH

• KMID: 2236807
• DOI: http://doi.org/10.4097/kjae.2001.40.3.365

Abstract

BACKGROUND: Local anesthetics are often used for a regional block in patients who are being treated with calcium channel blockers (CCB). Bupivacaine is a local anesthetic with potential for serious cardiovascular toxicity. Ropivacaine is a relatively new local anesthetic. It is clinically equipotent and chemically similar to bupivacaine. Diltiazem (CCB) is a potent coronary and systemic vasodilator with antiarrhythmic properties. Local anesthetics such as bupivacaine and ropivacaine have been suggested to show drug interactions with diltiazem. Therefore, we tried to observe the drug interactions between bupivacaine, ropivacaine and diltiazem using an animal model.
METHODS
This study was performed using an isolated rat heart (N = 40) by the Langendorff method. After a stabilization period, all hearts were subjected to the application of local anesthetics of a 1 microgram/ml or 3/ml concentration, respectively. Thereafter, they were subdivided into four groups; the bupivacaine (B) group, bupivacaine with diltiazem (BD) group, ropivacaine (R) group, and ropivacaine with diltiazem (RD) group. Parameters such as, LVP, dp/dt, heart rate (HR), coronary flow (CF), DO2, and MVO2 were measured.
RESULTS
All parameters decreased in all groups, respectively (P < 0.05). The BD group and R group showed a lower LVP and dp/dt than those of the B group (P < 0.05). The BD group and B group showed lower HR than that of the R group (P < 0.05). The RD group showed a higher CF than other groups (P < 0.05).
CONCLUSIONS
The negative inotropic potency of bupivacaine was enhanced in the presence of diltiazem. We suggest that diltiazem has a protective effect against reduction of CF by ropivacaine. Therefore, we should consider this when selecting local anesthetics for cardiovascular patients under the treatment of diltiazem.

Keyword

Anesthetics, local: bupivacaine; ropivacaine; Animals: rats; Heart: contractility; coronary flow; Pharmacology: diltiazem

MeSH Terms

Anesthetics, Local
Animals
Bupivacaine*
Calcium Channel Blockers
Diltiazem*
Drug Interactions
Heart Rate
Heart*
Humans
Models, Animal
Rats*
Anesthetics, Local
Bupivacaine
Calcium Channel Blockers
Diltiazem