title: Comparative study related to cardiovascular safety between bupivacaine (S75-R25) and ropivacaine in brachial plexus block.
abstract: OBJECTIVE
  Bupivacaine is a first choice for regional anesthesia considering its effectiveness, long duration and less motor blockade. Bupivacaine (S75-R25) is a mixture of optical isomers containing 75% levobupivacaine (S-) and 25% dextrobupivacaine (R+) created by a Brazilian pharmaceutical company. This investigation compared cardiac safety and efficacy of bupivacaine S75-R25 with vasoconstrictor and ropivacaine for brachial plexus blockade.
  
  
  METHODS
  Patients were randomized to receive brachial plexus anesthesia with either bupivacaine S75-R25 with epinephrine 1:200,000 (bupi) or ropivacaine (ropi), both at 0.50%, in 30 mL solution. We registered a continuous Holter ECG throughout the procedure, as well as the Lovett scale of force in addition to monitoring (heart rate, pulse oximetry and non-invasive blood pressure). The incidence of adverse events was compared with the chi-square or Fisher test.
  
  
  RESULTS
  We allocated forty-four patients into two groups. They did not show any difference related to age, weight or height, gender, as well as for surgical duration. Supraventricular arrhythmias were not different before or after the plexus blockade, independent of the local anesthetic chosen. Loss of sensitivity was faster for the bupivacaine group (23.1 ± 11.7 min) compared to the ropivacaine one (26.8 ± 11.5 min), though not significant (p = 0.205, Student t). There was a reduction in the cardiac rate, observed during the twenty-four-hour Holter monitoring.
  
  
  CONCLUSIONS
  This study showed similar efficacy between bupivacaine S75-R25 for brachial plexus blockade and ropivacaine, with similar incidences of supraventricular arrhythmias.
authors.affiliation: MD, PhD, Anesthesiologist, Instituto de Ortopedia of Hospital das Clínicas of Universidade de São Paulo (USP) Medical School, SP, Brazil.
authors.forename: Adilson
authors.initials: A
authors.lastname: Hamaji
authors.affiliation: MD, PhD, Orthopedic Surgeon, Instituto de Ortopedia of Hospital das Clínicas of USP Medical School, SP, Brazil.
authors.forename: Marcelo Rosa de
authors.initials: MR
authors.lastname: Rezende
authors.affiliation: MD, PhD, Associate Professor, Orthopedics and Traumatology Department, USP Medical School, SP, Brazil.
authors.forename: Rames
authors.initials: R
authors.lastname: Mattar
authors.affiliation: MD, PhD, Associate Professor of Anesthesiology, Surgery Department, USP Medical School; Anesthesiologist, Instituto de Ortopedia of Hospital das Clínicas, USP Medical School, SP, Brazil. Electronic address: joaquimev@usp.br.
authors.forename: Joaquim Edson
authors.initials: JE
authors.lastname: Vieira
authors.affiliation: MD, PhD, Professor of Anesthesiology, Surgery Department, USP Medical School, SP, Brazil.
authors.forename: José Otávio Costa
authors.initials: JO
authors.lastname: Auler
mesh_terms: D000328:Adult; D000577:Amides / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D065527:Brachial Plexus Block / Q000009:adverse effects*; D002045:Bupivacaine / Q000009:adverse effects*; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006321:Heart / Q000187:drug effects*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D002045:Bupivacaine
keywords: Ambulatory; Amides; Anesthesia; Brachial Plexus; Bupivacaine; Conduction; Electrocardiography; Stereoisomerism.; ropivacaine