The effects of lidocaine on bupivacaine-induced cardiotoxicity in the isolated rat heart

Abstract

Bupivacaine is a widely used long-acting local anaesthetic. In clinical practice, a mixture of bupivacaine and lidocaine is often used in order to combine the faster onset of sensory blockade of lidocaine with more profound and longer duration of blockade by bupivacaine. The aim of this study was to compare the cardiotoxicity of large doses of bupivacaine and mixture of bupivacaine with lidocaine in the isolated rat heart and to estimate whether or not the addition of lidocaine in clinically relevant concentration increases bupivacaine-induced toxicity. Experiments were performed on 21 adult male rats divided into three groups: B (6 µg/ml bupivacaine), BL (6 µg/ml bupivacaine and 12 µg/ml lidocaine) and L (12 µg/ml lidocaine). The experiment consisted of three 30 min periods: stabilisation, perfusion and washout. The isolated hearts were perfused according to Langendorff with Krebs-Henseleit solution at constant pressure (80 mmHg) and 37 °C (CaCl2 1.25 mM) and the heart rate (based on RR interval assessment), PQ and QRS intervals were measured. The present study shows that the mixture of tested anaesthetics – bupivacaine and lidocaine – impairs the intraventricular conduction parameters (QRS interval prolongation) to a lesser extent than bupivacaine itself, and that this effect is marked mainly at the beginning of perfusion.