Comparison of cardiotoxicity of levobupivacaine and bupivacaine with the brain natriuretic peptide

Introduction: Local anesthetics are also considered to be potentially toxic to the cardiovascular system since they act on ion channels in nerve cell membranes as well as in other tissues that can be stimulated.

Aim: In this study we aimed to compare cardiotoxicity levels of both drugs with brain natriuretic peptide (BNP) protein level in patients undergoing combined spinal epidural anesthesia and postoperative analgesia when given bupivacaine and levobupivacaine at equipotent doses.

Materyal and Method: In this prospective, randomized, double-blind study a total of 30 patients, aged 25-70 years, who were included in the American Society of Anesthesiologists (ASA) I-III risk class and underwent total knee arthroplasty surgery, were included in the study. Patients were randomized as Group I (n = 15) Levobupivacaine and Group II (n = 15) bupivacaine and combined spinal-epidural anesthesia was administered. The operation follow-up of patients were evaluated with the systolic arterial pressure (SAB), the diastolic arterial pressure (DAB), the mean arterial pressure (MAP) and the heart rate (HR), and postoperative follow-up with SAB, DAB, KH, visual analogue scale (VAS) values were monitored at zero minute, 1st, 6th, 12th and 24th hour. BNP levels were measured at 5th minute after spinal anesthesia, sensory block at thoracal level 10 and post-operative 24th hour.

Results: A statistically significant difference was found in the VAS values ​​measured at postoperative 12th hour and 24th hour in favor of levobupivacaine group (p <0.05). In the comparison of BNP levels between the groups, there was no statistically significant difference between the two groups at all measurement times (p> 0.05).

Conclusion: Similar results were obtained in intraoperative and postoperative BNP levels when using levobupivacaine and bupivacaine in equal doses for both spinal anesthesia and epidural analgesia.