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Association between levobupivacaine and pancuronium. Interference in neuromuscular transmission and blockade in rats
Vanessa Henriques Carvalho1, Angélica de Fátima de Assunção Braga2, Franklin Sarmento da Silva Braga3
1PhD, Department of Anesthesiology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Brazil. Intellectual, scientific and design of the study; acquisition and interpretation of data; technical procedures; manuscript preparation and writing, critical revision, supervised all phases of the study.
Purpose:
To evaluate the effects of levobupivacaine on neuromuscular transmission and neuromuscular blockade produced by pancuronium in vitro.
Methods:
Thirty rats were distributed into groups (n = 5) according to the drug used alone or in combination: Group I - levobupivacaine (5 µg.mL-1); Group II - pancuronium (2 µg.mL-1); Group III - pancuronium (2 µg.mL-1) + levobupivacaine (5µg.mL-1). The following parameters were evaluated: 1) amplitude of diaphragmatic response to indirect stimulation, before and 60 minutes after the addition of levobupivacaine and pancuronium alone, and after the addition of levobupivacaine combined with pancuronium; 2) membrane potentials (MP) and miniature endplate potentials (MEPP).
Results:
Levobupivacaine alone did not alter the amplitude of muscle response and MP. In preparations previoulsy exposed to levobupivacaine, the block with pancuronium was significantly denser (90.2 ± 15.2%), showing a significant difference (p=0.031) in comparison to the block produced by pancuronium alone (48.9% ± 9.8%). There was a decrease in the frequency and amplitude of MEPPs.
Conclusion:
Levobupivacaine potentiated the neuromuscular blockade produced by pancuronium, confirming a presynaptic action by a decrease in miniature endplate potentials.
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