1
|
Alfirevic A, Almonacid-Cardenas F, Yalcin EK, Shah K, Kelava M, Sessler DI, Turan A. Blood bupivacaine concentrations after pecto-serratus and serratus anterior plane injections of plain and liposomal bupivacaine in robotically-assisted mitral valve surgery: Sub-study of a randomized trial. J Clin Anesth 2024; 95:111470. [PMID: 38604047 DOI: 10.1016/j.jclinane.2024.111470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/06/2024] [Accepted: 04/07/2024] [Indexed: 04/13/2024]
Abstract
STUDY OBJECTIVE To investigate the timing of peak blood concentrations and potential toxicity when using a combination of plain and liposomal bupivacaine for thoracic fascial plane blocks. DESIGN Pharmacokinetic analysis. SETTING Operating room. PATIENTS Eighteen adult patients undergoing robotically-assisted mitral valve surgery. INTERVENTIONS Ultrasound-guided pecto-serratus and serratus anterior plane blocks using a mixture of 0.5% bupivacaine HCl up to 2.5 mg/kg and liposomal bupivacaine up to 266 mg. MEASUREMENTS Arterial plasma bupivacaine concentration. MAIN RESULTS Samples from 13 participants were analyzed. There was substantial inter-patient variability in plasma concentrations. A geometric mean maximum bupivacaine concentration was 1492 ng/ml (range 660 to 4650 ng/ml) at median time of 30 min after injection. In 4/13 (31%) patients, plasma bupivacaine concentrations exceeded our predefined 2000 ng/ml toxic threshold. A second much smaller peak was observed about 32 h after the injection. No obvious signs of local anesthetic toxicity were observed. CONCLUSIONS Combined injection of plain and liposomal bupivacaine for pecto-serratus/serratus anterior plane blocks produced a biphasic pattern, with the highest arterial plasma concentrations observed within 30 min. Maximum concentrations exceeded the potential toxic threshold in nearly a third of patients, but without clinical evidence of toxicity. Clinicians should not assume that routine combinations of plain and liposomal bupivacaine for thoracic fascial plane blocks are inherently safe.
Collapse
Affiliation(s)
- Andrej Alfirevic
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, USA.
| | | | - Esra Kutlu Yalcin
- Division of Multi-specialty Anesthesiology, Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Karan Shah
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Marta Kelava
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel I Sessler
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Alparslan Turan
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, USA; Division of Multi-specialty Anesthesiology, Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
2
|
Li Q, Xu S, Ou Y, Zhou L, Huang F, Jiang W, Xie H, Zou X, Gao J, Jin S, Zhou H, Huang Y, Pan Z, Liu J, Wang G, Li X, Sun C, Zhao L, Li L, Liu Q, Duan K, Wang S. Evaluating the efficacy and safety of perianal injection of liposomal ropivacaine HR18034 for postoperative analgesia following hemorrhoidectomy: A multicenter, randomized, double-blind, controlled phase II clinical trial. J Clin Anesth 2024; 97:111524. [PMID: 38941870 DOI: 10.1016/j.jclinane.2024.111524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 06/06/2024] [Accepted: 06/08/2024] [Indexed: 06/30/2024]
Abstract
STUDY OBJECTIVE HR18034, composed of the ropivacaine encapsulated in multi-lamellar, concentric circular structure liposomes as the major component and a small amount of free ropivacaine, has performed well in animal experiments and phase I clinical trials. This trial was to investigate the efficacy, safety, pharmacokinetic profile and the minimum effective dose of HR18034 for postoperative analgesia after hemorrhoidectomy compared with ropivacaine. DESIGN A multicenter, randomized, double-blind trial. SETTING 19 medical centers in China. PATIENTS 85 patients undergoing hemorrhoidectomy between October 2022 to November 2022. INTERVENTIONS Patients were randomly divided into HR 18034 190 mg group, 285 mg group, 380 mg group and ropivacaine 75 mg group, receiving single local anesthetic perianal injection for postoperative analgesia. MEASUREMENTS The primary outcome was the area under the resting state NRS score -time curve within 72 h after injection. The second outcomes included the proportion of patients without pain, the proportion of patients not requiring rescue analgesia, cumulative morphine consumption for rescue analgesia, etc. Safety was evaluated by adverse events incidence and plasma ropivacaine concentrations were measured to explore the pharmacokinetic characteristics of HR18034. MAIN RESULTS The areas under the NRS score (at rest and moving states)-time curve were significantly lower in HR 18034 380 mg group than ropivacaine 75 mg at 24 h, 48 h, and 72 h after administration. However, this superiority was not observed in HR18034 190 mg group and 285 mg group. There was no difference in cumulative morphine consumption for rescue analgesia between HR 18034 groups and ropivacaine group. CONCLUSIONS HR 18034 380 mg showed superior analgesic efficacy and equivalent safety compared to ropivacaine 75 mg after hemorrhoidectomy, thus preliminarily determined as minimum effective dose.
Collapse
Affiliation(s)
- Qiuwen Li
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China
| | - Shouyu Xu
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China
| | - Yangwen Ou
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China
| | - Lianbang Zhou
- The Second Affiliated Hospital of Anhui Medical University, Hefei 230022, People's Republic of China
| | - Furong Huang
- The First People's Hospital of Changde, Changde, People's Republic of China
| | - Wanwei Jiang
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116011, People's Republic of China
| | - Haihui Xie
- Dongguan people's Hospital, Dongguan, Guangdong, People's Republic of China
| | - Xiaohua Zou
- The Affiliated Hospital of Guizhou Medical University, Guiyang, People's Republic of China
| | - Jihua Gao
- Traditional Chinese Medicine Hospital of Hebei Province, Shijiazhang,People's Republic of China
| | - Shu''an Jin
- Central Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Hongmei Zhou
- Jiaxing Second Hospital, Jiaxing, People's Republic of China
| | - Yanjuan Huang
- Nanning Second People's Hospital, Nanning, People's Republic of China
| | - Zhihao Pan
- Li Huili Hospital of Ningbo Medical Center, Ningbo, People's Republic of China
| | - Juying Liu
- Taihe Hospital Affiliated Hospital of Hubei University of medicine, Shiyan, People's Republic of China
| | - Guyan Wang
- Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing, People's Republic of China
| | - Xiangkui Li
- Sichuan Provincial People's Hospital, Chengdu, People's Republic of China
| | - CanLin Sun
- Taizhou People's Hospital, Taizhou, People's Republic of China
| | - Ling Zhao
- The First Affiliated Hospital of Xi'an Medical University, Xi'an, People's Republic of China
| | - Lin Li
- General Hospital of Northern Theater Command, Shenyang, People's Republic of China
| | - Qin Liu
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Kaiming Duan
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China
| | - Saiying Wang
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China.
| |
Collapse
|
3
|
Abstract
This paper is the forty-fifth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2022 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
Collapse
Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, USA.
| |
Collapse
|
4
|
Thuppal S, Crabtree T. Liposomal Bupivacaine: A Boon or Bane for Postlobectomy Pain Management? Ann Thorac Surg 2023; 116:654-655. [PMID: 37625892 DOI: 10.1016/j.athoracsur.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Sowmyanarayanan Thuppal
- Division of Cardiothoracic Surgery, Department of Surgery, Southern Illinois University School of Medicine, 701 N First St, Springfield, IL 62794
| | - Traves Crabtree
- Division of Cardiothoracic Surgery, Department of Surgery, Southern Illinois University School of Medicine, 701 N First St, Springfield, IL 62794.
| |
Collapse
|
5
|
Kuckelman J, Miller D. Importance of Technique for Thoracic Field Block Using Expanded Liposomal Bupivacaine. Ann Thorac Surg 2023; 116:654. [PMID: 36841497 DOI: 10.1016/j.athoracsur.2023.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/11/2023] [Indexed: 02/27/2023]
Affiliation(s)
- John Kuckelman
- Department of Thoracic Surgery, Augusta University, 1120 15th St, BA 4300, Augusta, GA 30912.
| | - Daniel Miller
- Department of Thoracic Surgery, Augusta University, 1120 15th St, BA 4300, Augusta, GA 30912
| |
Collapse
|