Comparation Of The Myotoxic Effects Of Levobupivacaine, Bupivacaine And Ropivacaine; Electron Microscopic Study
Özlem Öz Gergin1, Karamehmet Yıldız2, Adnan Bayram2, Leman Sencar4, Gülfidan Coşkun4, Arzu Yay3, Cihangir Biçer2, Saim Özdamar3, Sait Polat4
1Department of Anaesthesiology, Kayseri Education and Research Hospital, Kayseri, Turkey
2Department of Anaesthesiology, Erciyes University, Medical Faculty, Kayseri, Turkey
3Department of Histology and Embryology, Erciyes University, Faculty of Medicine, Kayseri, Turkey
4Department of Histology and Embryology, Cukurova University, Faculty of Medicine, Adana, Turkey
OBJECTIVE: The aim of this study was to investigate the myotoxic effects of bupivacaine, ropivacaine and levobupivacaine which were applied to rat skeletal muscle intramuscularly. MATERIAL-METHOD: Forty Wistar-Albino rats were divided into 4 groups. 0.5% bupivacaine (Group B), 0.5% ropivacaine (Group R) and 0.5% levobupivacaine (Group L) and 0.9% normal saline (Group SF) were applied intramuscularly to right gastrocinemius muscle of rats. The rats in each groups were sacrificed on second day after injection. Sections of muscle samples were stained with hematoxylin-eosin for light microscopic investigation and prepared to evaluate ultrastructural changes in the subcellular level with transmission electron microscopy. RESULTS: Muscle damage of Group B, Group L and R on second day after injection were significantly higher than Group SF in the light microscopic examination. The most observed muscle damage was observed in Group B [Damage Score = 3.0 (2.0-3.0)], muscle damage of Group R was less than Group B [Damage Score = 2.0 (2.0-3.0)] and the least in Group L [Damage Score = 1.0 (1.0-1.0)] quantitatively (p <0.05). Electron microscopic examination of each of the three local anesthetic agents that caused cellular damage was qualitatively similar. Fragmentation in the inner membrane of muscle fibers, the formation of membranous whorl and expansion of the sarcoplasmic reticulum cisternas were observed in electron microscopic investigation of the groups treated with local anesthetics. The subcellular damage were observed the most in the group of bupivacaine, in the group of ropivacaine less than the group of bupivacaine, the least in the group of levobupivacaine. CONCLUSION: The results indicated that bupivacaine caused more myotoxic damage than the other two agents in skeletal muscle of the rats, levobupivacaine caused less myotoxic damage than the both of the bupivacaine and ropivacaine at the cell and tissue levels in the light and electron microscopy.
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