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Wednesday, May 20, 2015

Comparison between Bupivacaine and Ropivacaine

Table 1: Comparison between Bupivacaine and Ropivacaine

Bupivacaine
Ropivacaine
Description [1]
Amide
Amide
Relative Potency [1]
8
6
Onset [1]
10 – 15 mins
10 – 15 mins
Duration [1]
(without Epinephrine)
3 – 12 h
3 – 12 h
Duration [1]
(with Epinephrine)
4 – 12 h
4 – 12 h
Maximum dose [1]
(without Epinephrine)
2.0 mg/kg
3.0 mg/kg
Maximum dose [1]
(with Epinephrine)
2.5  mg/kg
4.0 mg/kg
ADRs
More cardiotoxic [1] (hypotension & bradycardia) [2]
GI disorders: nausea, vomiting, Renal & urinary disorders (retention or incontinence), postdural puncture headache. [2]
Less cardiotoxic with better safety margin. [1]
Vascular disorder (hypotension), nausea, vomiting, urinary retention, hyperthermia, rigor, backpain, hypertension, bradycardia, tachycardia, paraesthesia, dizziness, headache. [4]
Pharmacokinetics
Muscular relaxation of lower extremities last 2-2.5 h.
Blockage of abdominal muscle lasts 45- 60 mins. [3]
Exhibits complete & biphasic absorption from epidural space with half lives of the two phases of the order as 14 mins and 4 h for adults.
Renal Cl: 1 ml/min
Total plasma clearance: 440 ml/min
Vd: 47 L, Terminal half life: 1.8 h after IV
Excretion: 86% urine
Slow absorption is the rate limiting factor which explains why the apparent elimination half life is longer after epidural than after IV administration. [4]
Pharmacodynamics
Long acting with moderate muscular relaxation of lower extremities. Allows motor blockade of the abdominal muscles. Bupivacaine heavy is hyperbaric and its initial spread in the intrathecal space is affected by gravity. [3]
Has anaesthetic and analgesic activity.
At high doses: surgical anaesthesia
Lower dose: sensory block with limited and non-progressive motor block. [4]
Storage
Do not store above 250C  for unopened vial [3]
Do not store above 30 o C. Do not freeze
Stability
Discard unused solution [3]
Discard any unused solution [4]
Incompatibilities
N/A
Precipitates in alkaline solution with pH>6 [4]

 References: 
  1.     http://www.frca.co.uk/article.aspx?articleid=100816
  2.     http://e-safe-anaesthesia.org/e_library/09/Subarachnoid_Block_TOTW_059_2007.pdf
  3.     https://www.medicines.org.uk/emc/medicine/185#EXCIPIENTS
  4.     https://www.medicines.org.uk/emc/medicine/7290


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