Electrocardiographic and blood pressure alterations caused by intravenous injection of ropivacaine – a study in piglets

Summary Objectives Objective signs to detect inadvertent intravascular injection of local anesthetics are essential in the anesthetized pediatric patient. For early detection of intravenous bupivacaine administration, it was shown that an epinephrine containing test dose reliably provoked T‐wave alterations, changes in heart rate ( HR ) and blood pressure, whereas intravenous injection of plain bupivacaine could not be detected until high doses were applied. This study investigates electrocardiographic and hemodynamic alterations caused by intravenous ropivacaine. Methods Twenty‐four piglets, anesthetized with sevoflurane, were randomized into two groups: Group R received as test dose plain ropivacaine 0.2% and group RE , ropivacaine 0.2% + epinephrine 5 μg·ml −1 . Under stable conditions, 0.2 ml kg −1 of the test solution was intravenously injected. Twenty minutes later, 0.4 ml kg −1 was applied. A positive effect was defined as HR increase ≥10 bpm, increase in mean arterial pressure ( MAP ) ≥15 mmHg, T‐wave increase ≥25% baseline. In another setting ropivacaine was intravenously infused until cardiac arrest. Results After injection of 0.2 or 0.4 ml kg −1 test solution, a positive increase in HR and MAP was found in 0% of group R and in 100% of group RE . An increase in T‐wave ≥25% was found in 42% of group R and in 100% of group RE . During intoxication, T‐elevation was seen in 83%. Conclusions An epinephrine containing test dose ropivacaine reliably provoked T‐wave elevations and increases in HR and MAP . A small dose plain ropivacaine caused T‐elevations in a remarkable percentage, whereas higher, quite toxic doses provoked T‐elevations in most of the pigs.