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Correspondence  |   January 2000
Ropivacaine: Drug of Choice? Or Not?
Author Notes
  • autore@axrma.uniromal.it
  • Department of Cardiovascular and Respiratory Sciences
  • Policlinico Umberto I
  • Rome, Italy
Article Information
Correspondence
Correspondence   |   January 2000
Ropivacaine: Drug of Choice? Or Not?
Anesthesiology 1 2000, Vol.92, 286. doi:
Anesthesiology 1 2000, Vol.92, 286. doi:
In Reply:—
We appreciate the comments of Dr. Camann regarding our case report on anesthetic management of three cases of hypertrophic cardiomyopathy receiving epidural anesthesia for cesarean delivery. 1 We agree with Dr. Camann regarding the evidence that local anesthetic–induced cardiotoxicity should only occur with large intravascular doses of these drugs. We also believe that a titrated epidural dose of local anesthetic is unlikely to result in cardiotoxic effects. 2 Carefully titrated lidocaine is also compatible with stable hemodynamics, but it is our opinion that the slower the onset of block is, the milder the effect on hemodynamics. Therefore, we thought that it would be better to use, in the same careful way, an anesthetic drug with longer onset time such as ropivacaine. Ropivacaine can have a fast onset time if given rapidly in large doses but not with careful titration, as we used in case 3. Moreover, at the time of our study, there was evidence that ropivacaine had less potential for central nervous system and cardiovascular toxicity 3 and produced less motor block of shorter duration when compared with bupivacaine. 4 Accordingly, we used ropivacaine as the “drug of choice” (i.e.  , as the drug that seemed to offer the best theoretical possibilities for the patients in question) once it became available at our hospital. We have successfully treated three additional patients with hypertrophic cardiomyopathy with ropivacaine epidural anesthesia (unpublished data). Nevertheless, in light of comments by Polley et al.  5 regarding the therapeutic indices of bupivacaine and ropivacaine, it would not be unreasonable to reconsider using bupivacaine or, in the near future, l  -bupivacaine in patients with hypertrophic cardiomyopathy.
References
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Datta S, Camann WR, Bader AM, VanderBurgh L: Clinical effects and maternal and fetal plasma concentrations of epidural ropivacaine vs. bupivacaine for cesarean section. A NESTHESIOLOGY 1995; 82:1346–52Datta, S Camann, WR Bader, AM VanderBurgh, L
Knudsen K, Suurkula MB, Blomberg S, Sjorvali J, Edvardsson N: Central nervous and cardiovascular effects of e.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth 1997; 78:507–14Knudsen, K Suurkula, MB Blomberg, S Sjorvali, J Edvardsson, N
Griffin RP, Reynolds F: Extradural anaesthesia for caesarean section: A double blind comparison of 0.5% ropivacaine with 0.5% bupivacaine. Br J Anaesth 1995; 74:512–6Griffin, RP Reynolds, F
Polley LS, Coulomb MO, Naughton N, Wagner DS, Van de Ven CJ: Relative analgesic potencies of ropivacaine and bupivacaine for epidural analgesia in labor: Implications for therapeutic indexes. A NESTHESIOLOGY 1999; 90:944–50Polley, LS Coulomb, MO Naughton, N Wagner, DS Van de Ven, CJ