Sodium bicarbonate reverts electrophysiologic cardiotoxicity of ropivacaine faster than lipid emulsions in a porcine model



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Zaballos García, Matilde and Fernández, Ignacio and Melone, Arturo and Rodríguez, Lucía and Varela, Olalla and García, Sergio and Quintela Jorge, Oscar and Vazquez, Elena and Anadón Baselga, María José and Almendral, Jesús (2022) Sodium bicarbonate reverts electrophysiologic cardiotoxicity of ropivacaine faster than lipid emulsions in a porcine model. Basic & Clinical Pharmacology & Toxicology . ISSN 1742-7835

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Ropivacaine has been described as a safer local anaesthetic (LA); however, serious cardiotoxic accidents have been reported. Intravenous-lipid-emulsion (ILE) therapy during LA intoxication seems to act as an antidote. Sodium bicarbonate is the standard treatment for sodium channel blocker drug toxicity. We compared both antidotes on the reversion of electrophysiologic toxicity induced by ropivacaine. Ropivacaine 5 mg kg1 was administered in 24 pigs, and 3 min later, the animals received ILE: 1.5 ml kg1 + 0.25 ml kg1 min1 (ILE group); sodium bicarbonate: 2 mEq kg1 + 1 mEq kg1 h1 (NaHCO3 group); saline solution (CTL group). Electrophysiological parameters were evaluated for 30 min. The area under the curve (AUC) for the first 5 or 30 min was compared between groups. Ropivacaine induced a lengthening of the PR interval by 17% (P = 0.0001), His-ventricle-interval by 58% (P = 0.001), sinus QRS complex by 56% (P = 0.0001), paced QRS at 150 bpm by 257% (P = 0.0001), and at 120 bpm by 143% (P = 0.0001) in all groups. At 5 min after treatment, sinus QRS in the NaHCO3 group was shorter than that in the CTL group (AUCQRS5, P = 0.003) or ILE group (AUCQRS5, P = 0.045). During the first minute, seven of the animals in the NaHCO3 group vs. two in the ILE or 0 in the CTL group recovered more than 30% of the sinus QRS previously lengthened by ropivacaine (P = 0.003). Sodium bicarbonate reversed the electrophysiological toxicity of ropivacaine faster than ILE and control groups.

Item Type:Article
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CRUE-CSIC (Acuerdos Transformativos 2022)

Uncontrolled Keywords:cardiotoxicity, lipid emulsions, ropivacaine, sodium bicarbonate
Subjects:Medical sciences > Medicine > Cardiology
Medical sciences > Medicine > Medical jurisprudence
ID Code:76055
Deposited On:21 Dec 2022 11:19
Last Modified:21 Dec 2022 11:19

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