Potassium channel agonists modify the local anaesthetic activity of bupivacaine in mice

Anaesthetic benefits of a ternary drug delivery system (Ropivacaine-in-Cyclodextrin-in-Liposomes): in-vitro and in-vivo evaluation

OBJECTIVES

To evaluate whether a ternary system composed of hydroxypropyl-β-cyclodextrin (HP-βCD) further encapsulated into egg phosphatidylcholine liposomes (LUV) could prolong the action and reduce the toxicity of ropivacaine (RVC).

METHODS

Dynamic light scattering and NMR were used to characterize the inclusion complex (RVC : HP-βCD), liposomal (RVC : LUV) and ternary (LUV : RVC : HP-βCD) systems containing 0.25% RVC. Their encapsulation efficiency, release kinetics, in-vitro cytotoxicity and in-vivo anaesthetic effect (paw-withdraw tests in mice) were also evaluated.

KEY FINDINGS

1 : 1 RVC : HP-βCD inclusion complex was encapsulated in liposomes (220.2 ± 20.3 nm size, polydispersity <0.25, zeta potentials = -31.7 ± 1.4 mV). NMR (diffusion-ordered spectroscopy (DOSY)) revealed stronger anaesthetic binding to LUV : RVC : HP-βCD (K_a  = 342 m^-1 ) than to RVC : HP-βCD (K_a  = 128 m^-1 ) or liposomal formulation (K_a  = 22 m^-1 ). The formulations promoted in-vitro sustained drug release and partially reverted the cytotoxicity of RVC against 3T3 fibroblasts in the profile: LUV : RVC : HP-βCD ≥ RVC : HP-βCD > RVC : LUV. Accordingly, in-vivo sensory block of free RVC (180 min) was prolonged ca. 1.7 times with the ternary system and RVC : HP-βCD (300 min) and 1.3 times with RVC : LUV (240 min).

CONCLUSIONS

These results confirm the suitability of this double-carrier system in clinical practice, to decrease the toxicity and prolong the anaesthesia time evoked by RVC.

Ketamine effects on bupivacaine local anaesthetic activity and pharmacokinetics of bupivacaine in mice

This study was designed to document possible changes in bupivacaine (B) local anaesthetic activity and pharmacokinetics in mice after a ketamine (K) injection. In the experiments, bupivacaine (8.25 mg.kg(-1)), was injected into the popliteal space of the right posterior limb: the local anaesthetic activity was assessed according to a sciatic nerve blockade method with three different doses (2, 10 and 40 mg/kg) of ketamine and the kinetics were studied after a 10 mg/kg dose. When ketamine was associated, the local anesthetic activity of bupivacaine was significantly enhanced as well as its elimination half-life. Significantly lower levels of the main metabolite, PPX, were observed, when ketamine was associated, suggesting a metabolic inhibition phenomenon. The ketamine-induced increase in the total anaesthetic effect of bupivacaine may thus be explained by kinetic modifications i.e. a possible inhibiting effect of ketamine on the metabolism of bupivacaine.

Kinetics of bupivacaine after levcromakalim treatment in mice

Previous workers have reported that 0.01 mg kg-1 of levcromakalim injected intraperitoneally did not modify bupivacaine-induced neurotoxicity but increased the duration of action of bupivacaine. This study was designed to document possible changes in the pharmacokinetic behaviour of bupivacaine and its main metabolite, N-desbutylbupivacaine in mice after a single 0.01 mg kg-1 intraperitoneal injection of levcromakalim. The kinetic parameters of bupivacaine were determined after a single 20 mg kg-1 intraperitoneal injection of bupivacaine in controls and in levcromakalim-treated mice. It was found that levcromakalim did not change any kinetic parameters of bupivacaine or of its main metabolite, N-desbutylbupivacaine. The previously reported findings of the influence of the low dose (0.01 mg kg-1) of levcromakalim on bupivacaine-induced toxicity agree well with the lack of influence of 0.01 mg kg-1 of levcromakalim on bupivacaine and N-desbutylbupivacaine pharmacokinetics, although the reported increase in the duration of action of bupivacaine after levcromakalim treatment can hardly be explained by the pharmacokinetics of bupivacaine when associated with levcromakalim. We suggest that levcromakalim might interfere directly with ion-channel block caused by bupivacaine by altering conduction properties or indirectly by enhancing bupivacaine-induced voltage and time-dependent sodium-channel block.

Kinetics of bupivacaine after nicorandil treatment in mice

Previous studies have reported interactions between potassium-channel agonists and bupivacaine. This study was designed to document possible changes in the pharmacokinetic behaviour of bupivacaine and its main metabolite, N-desbutylbupivacaine, in mice after a single 1 mg kg-1 intraperitoneal injection of nicorandil. The kinetic variables of bupivacaine were determined after a single 20 mg kg-1 intraperitoneal dose of bupivacaine in controls (group 1) and in nicorandil-treated mice (group 2). The maximal concentration in the serum (Cmax 0.618 +/- 0.051 vs 0.408 +/- 0.041 microgram mL-1 for group 1 vs 2, P = 0.01) and the area under the concentration curve (AUC 1.039 +/- 0.051 vs 0.758 +/- 0.072 microgram mL-1 h for group 1 vs 2, P = 0.013) of bupivacaine were significantly lower in nicorandil-treated mice, while CL (0.579 +/- 0.025 vs 0.815 +/- 0.079 for group 1 vs 2, P = 0.022) and Vd (0.506 +/- 0.054 vs 0.981 +/- 0.117 for group 1 vs 2, P = 0.1006) were increased in nicorandil-treated animals. The ratio of AUC for N-desbutylbupivacaine to AUC for bupivacaine, which may partially indicate the rate of metabolism, was higher in the presence of nicorandil (1.142 +/- 0.017 compared with 0.877 +/- 0.013, P = 0.0001). Our data may indicate an increased metabolism of bupivacaine in nicorandil-treated mice. These results do not explain the previously reported enhanced anaesthetic activity of bupivacaine in the presence of nicorandil, but may participate, at least in part, in the relative protective effect of nicorandil against the previously reported bupivacaine-induced toxicity.