Agarwal Vaishali, Das Pravin K, Nath Soumya S, Tripathi Manoj, Tiwari Bhuwan
Department of Anaesthesiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Cardiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Indian J Anaesth. 2024 Oct;68(10):889-895. doi: 10.4103/ija.ija_1185_23. Epub 2024 Sep 14.
This study aimed to compare the effects of three local anaesthetic (LA) agents, namely bupivacaine, levobupivacaine, and ropivacaine, on the cardiac conduction system as assessed by corrected QT (QTc) and P wave dispersion (PWD) intervals in lower limb orthopaedic surgeries and to find the most suitable LA agent that can be used for a long duration.
The study included 75 patients with American Society of Anesthesiologists physical status I and II of either gender in the age group of 18-65 years undergoing elective lower limb orthopaedic surgeries under epidural anaesthesia. These were allocated to groups B (bupivacaine), L (levobupivacaine), and R (ropivacaine). We observed blood pressure, heart rate, respiratory rate, PWD, and QTc intervals from baseline value through Holter monitoring, pain assessment by visual analogue scale, and demand and total volume of LA consumed by patient-controlled analgesia devices. The repeated measures of ANOVA were carried out to find the effect of time and time-to-group interaction among the groups across the periods.
On intergroup comparison of QTc and PWD, no significant difference among groups was observed, but on intragroup analysis, a statistically significant increase in QTc and PWD from baseline was observed for each of groups B, L, and R at all time intervals. However, the mean increase in QTc and PWD recorded for Group B was higher than in groups L and R.
Bupivacaine has the maximal tendency to prolong QTc and PWD. All three agents showed comparable haemodynamic effects and time to onset of sensory and motor blockade.
本研究旨在比较三种局部麻醉药，即布比卡因、左旋布比卡因和罗哌卡因，在下肢骨科手术中对心脏传导系统的影响，通过校正QT（QTc）和P波离散度（PWD）间期进行评估，并找出可长时间使用的最合适局部麻醉药。
本研究纳入75例年龄在18 - 65岁、美国麻醉医师协会身体状况分级为Ⅰ级和Ⅱ级的择期下肢骨科手术患者，采用硬膜外麻醉，患者性别不限。将这些患者分为B组（布比卡因）、L组（左旋布比卡因）和R组（罗哌卡因）。通过动态心电图监测观察从基线值开始的血压、心率、呼吸频率、PWD和QTc间期，采用视觉模拟评分法进行疼痛评估，并记录患者自控镇痛装置的药物需求量和总用量。采用重复测量方差分析来确定各时间段内时间和组间时间交互作用的影响。
在QTc和PWD的组间比较中，未观察到组间有显著差异，但在组内分析中，B组、L组和R组在所有时间间隔的QTc和PWD均较基线有统计学意义的升高。然而，B组记录的QTc和PWD平均升高幅度高于L组和R组。
布比卡因延长QTc和PWD的倾向最大。所有三种药物在血流动力学效应以及感觉和运动阻滞起效时间方面表现相当。
