• Shigeo Ohmura, Akiko Sugano, Masayuki Kawada, and Ken Yamamoto.
• Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan. ohmura@med.kanazawa-u.ac.jp
• Anesth. Analg. 2003 Sep 1;97(3):893-7.

AbstractLocal anesthetic toxicity produced by an inadvertent IV injection is attenuated by the pulmonary uptake of local anesthetics. We compared the pulmonary uptake of ropivacaine and levobupivacaine after a bolus injection in rabbits. Sixteen anesthetized rabbits were randomly assigned to either a ropivacaine group or a levobupivacaine group. A bolus containing ropivacaine or levobupivacaine 0.5 mg/kg and indocyanine green (an intravascular indicator) 0.25 mg/kg was injected rapidly into the vena cava. Arterial blood samples were collected serially at 1.2-s intervals for 30 s. Concentrations of local anesthetic and indocyanine green in each sample were determined for the calculation of first-pass uptake of a local anesthetic in the lung. The first-pass uptake of levobupivacaine (31.4% +/- 8.3%; mean +/- SD) was larger than that of ropivacaine (22.9% +/- 5.6%), and the maximum arterial concentration of ropivacaine (21.2 +/- 2.8 micro g/mL) was larger than that of levobupivacaine (18.6 +/- 1.9 micro g/mL). We conclude that the pulmonary uptake of levobupivacaine is larger than that of ropivacaine after a bolus injection. Therefore, the advantages of ropivacaine over levobupivacaine in terms of less cardiovascular toxicity may be offset by the smaller pulmonary uptake after an inadvertent IV injection.

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