Ropivacaine May Have Advantages Compared to Bupivacaine in Porcine Endotoxemic Shock

Diana K Mutschler,Urban Gustafsson,Samar Basu,Anders O Larsson,Mats B Eriksson

doi:10.3109/2000-1967-035

Diana K Mutschler, Urban Gustafsson + Show 3 more

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https://doi.org/10.3109/2000-1967-035

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Abstract

Patients that undergo major abdominal surgery often receive epidural postoperative analgesia. Septic complications are frequently seen in this cohort. In a porcine model of endotoxemic shock, resembling human gram-negative septic shock, we evaluated the effects of two widely used local anaesthetics, bupivacaine and ropivacaine given intravenously. In the endotoxin-ropivacaine group mixed venous saturation and platelet count were higher as compared to endotoxemic controls. Mean arterial blood pressure and platelet count were higher in ropivacaine-endotoxin pigs than in bupivacaine-endotoxin ones. Bupivacaine augmented endotoxin-mediated decrease in left ventricular stroke work index. Ropivacaine displays pathophysiological advantages compared to bupivacaine in septic shock, which may be explained by improved tissue perfusion by ropivacaine.

Highlights

Septic complications may be seen in the postoperative phase; especially after major bowel surgery [1, 2]
In a porcine model of endotoxemic shock, resembling human gram-negative septic shock, we evaluated the effects of two widely used local anaesthetics, bupivacaine and ropivacaine given intravenously
The 5 pigs that received local anaesthetics, but not endotoxin remained physiologically stable in all variables throughout the 6 h experimental procedure

Summary

Introduction

Septic complications may be seen in the postoperative phase; especially after major bowel surgery [1, 2]. Intra-abdominal bacteria may enter the bloodstream and hereby cause a septic condition. This may progress to full-blown septic shock, a feared disorder with high mortality, which is frequently seen in intensive care units. Septic shock is associated with impairment of several vital functions e.g. decreased cardiac performance, pulmonary disturbances, production of lipid peroxidation metabolites, and activation of both the complement and the coagulation cascades [3, 4]. Gram-negative septic shock can be replicated by intravenous application of endotoxin in the anesthetized pig [5, 6].

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