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Lascelles BDX, Kirkby Shaw K. An extended release local anaesthetic: potential for future use in veterinary surgical patients? Vet Med Sci 2016; 2:229-238. [PMID: 29067198 PMCID: PMC5645851 DOI: 10.1002/vms3.43] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
One of the most effective means of preventing the transduction and transmission of acute and perioperative pain is through the use of local anaesthetics. However, local anaesthetics currently available have a relatively short duration of action. Although there are several tools available to treat perioperative pain in companion animals, overall, there is an unmet need for products that can be administered in the clinic, and provide pain relief for the crucial first few days following surgery in the home environment. Specifically, in relation to local anaesthetics, there is a clear unmet need for a long-acting local anaesthetic that can be added to the multimodal analgesic protocol to provide pain relief to patients in the home environment or during extended hospitalization. Bupivacaine liposomal injectable suspension recently became available for use in humans, and has proven efficacious and safe. This paper will review the use of local anaesthetics, particularly bupivacaine, in dogs and cats, and introduce a new formulation of prolonged release bupivacaine that is in development for dogs and cats.
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Affiliation(s)
- B. Duncan X. Lascelles
- Comparative Pain Research ProgramDepartment of Clinical SciencesCollege of Veterinary MedicineNorth Carolina State UniversityRaleighNorth Carolina
- Comparative Medicine Institute and Department of Clinical SciencesCollege of Veterinary MedicineNorth Carolina State UniversityRaleighNorth Carolina
- Center for Pain Research and InnovationUNC School of DentistryChapel HillNorth Carolina
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Lemoine S, Rouet R, Manrique A, Hanouz JL. Effect of long-chain triglyceride lipid emulsion on bupivacaine-induced changes in electrophysiological parameters of rabbit Purkinje cells. Fundam Clin Pharmacol 2013; 28:481-8. [PMID: 24279803 DOI: 10.1111/fcp.12058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 10/10/2013] [Accepted: 10/31/2013] [Indexed: 11/28/2022]
Abstract
Lipid emulsions are used in the reversal of local anesthetic toxicity. The aim of this study was to investigate the cellular electrophysiological effects of long-chain triglyceride lipid emulsion (LCTE) on cardiac action potential characteristics and conduction disturbances induced by bupivacaine. Purkinje fibers were dissected from the left ventricle of New Zealand white rabbit hearts and superfused with either Tyrode's solution during 30 min (control group), with bupivacaine 10(-6) M, 10(-5) M, and 5.10(-5) M alone, or in the presence of LCTE 0.5%, in addition, LCTE at 0.1%, 0.5%, and 1% was perfused alone. Electrophysiological parameters were recorded using the conventional microelectrode technique (37 °C, 1 Hz frequency). Bupivacaine 5.10(-5) M-induced conduction blocks (8/8 preparations): LCTE 0.5% suppressed the bupivacaine 5.10(-5) M-induced conduction blocks (1/8 preparations). Exposure to bupivacaine 10(-6) M, 10(-5) M, and 5.10(-5) M resulted in a significant decrease in the maximal rate of depolarization (Vmax) (respectively, 25%, 55%, 75%; P < 0.002 vs. control group). In the presence of LCTE 0.5%, bupivacaine 10(-6) M did not significantly decreased Vmax (13%; P = 0.10 vs. control group). The decrease in Vmax resulting from bupivacaine 10(-5) M alone was significantly less in the presence of LCTE 0.5% (P < 0.01 vs. bupivacaine 10(-5) M alone). Exposure to bupivacaine 10(-6) M, 10(-5) M, and 5.10(-5) M alone or in the presence of LCTE 0.5% resulted in a significant decrease in action potential duration measured at 50% and 90% repolarization (APD50 and APD90; P < 0.01 vs. control group). LCTE inhibited the Purkinje fibers conduction blocks induced by bupivacaine. Moreover, LCTE 0.5% attenuates the decrease in Vmax induced by bupivacaine 10(-6) M and 10(-5) M.
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Affiliation(s)
- Sandrine Lemoine
- Department of Anesthesiology and Intensive Care, Centre Hospitalier Universitaire de Caen, Caen, France; Normandie Université, EA4650, Signalisation, Electrophysiologie et Imagerie des Lésions d'Ischémie-reperfusion Myocardique, Centre Hospitalier Universitaire de Caen, Caen, France
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Hardie EM, Lascelles BDX, Meuten T, Davidson GS, Papich MG, Hansen BD. Evaluation of intermittent infusion of bupivacaine into surgical wounds of dogs postoperatively. Vet J 2011; 190:287-289. [DOI: 10.1016/j.tvjl.2010.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 11/02/2010] [Accepted: 11/05/2010] [Indexed: 10/18/2022]
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Tsuchiya H, Ueno T, Mizogami M, Takakura K. Local anesthetics structure-dependently interact with anionic phospholipid membranes to modify the fluidity. Chem Biol Interact 2010; 183:19-24. [PMID: 19853592 DOI: 10.1016/j.cbi.2009.10.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 10/04/2009] [Accepted: 10/12/2009] [Indexed: 10/20/2022]
Abstract
While bupivacaine is more cardiotoxic than other local anesthetics, the mechanistic background for different toxic effects remains unclear. Several cardiotoxic compounds act on lipid bilayers to change the physicochemical properties of membranes. We comparatively studied the interaction of local anesthetics with lipid membranous systems which might be related to their structure-selective cardiotoxicity. Amide local anesthetics (10-300 microM) were reacted with unilamellar vesicles which were prepared with different phospholipids and cholesterol of varying lipid compositions. They were compared on the potencies to modify membrane fluidity by measuring fluorescence polarization. Local anesthetics interacted with liposomal membranes to increase the fluidity. Increasing anionic phospholipids in membranes enhanced the membrane-fluidizing effects of local anesthetics with the potency being cardiolipin>>phosphatidic acid>phosphatidylglycerol>phosphatidylserine. Cardiolipin was most effective on bupivacaine, followed by ropivacaine. Local anesthetics interacted differently with biomimetic membranes consisting of 10mol% cardiolipin, 50mol% other phospholipids and 40mol% cholesterol with the potency being bupivacaine>>ropivacaine>lidocaine>prilocaine, which agreed with the rank order of cardiotoxicity. Bupivacaine significantly fluidized 2.5-12.5mol% cardiolipin-containing membranes at cardiotoxicologically relevant concentrations. Bupivacaine is considered to affect lipid bilayers by interacting electrostatically with negatively charged cardiolipin head groups and hydrophobically with phospholipid acyl chains. The structure-dependent interaction with lipid membranes containing cardiolipin, which is preferentially localized in cardiomyocyte mitochondrial membranes, may be a mechanistic clue to explain the structure-selective cardiotoxicity of local anesthetics.
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Affiliation(s)
- Hironori Tsuchiya
- Department of Dental Basic Education, Asahi University School of Dentistry, 1851-1 Hozumi, Mizuho, Gifu 501-0296, Japan.
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MacDougall LM, Hethey JA, Livingston A, Clark C, Shmon CL, Duke-Novakovski T. Antinociceptive, cardiopulmonary, and sedative effects of five intravenous infusion rates of lidocaine in conscious dogs. Vet Anaesth Analg 2009; 36:512-22. [DOI: 10.1111/j.1467-2995.2009.00480.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bernard F, Kudnig ST, Monnet E. Hemodynamic Effects of Interpleural Lidocaine and Bupivacaine Combination in Anesthetized Dogs with and Without an Open Pericardium. Vet Surg 2006; 35:252-8. [PMID: 16635004 DOI: 10.1111/j.1532-950x.2006.00135.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify dysrhythmias and hemodynamic changes after lidocaine and bupivacaine infusion into the interpleural space with an open pericardium. STUDY DESIGN Experimental study. ANIMALS Six adult dogs. METHODS Systemic arterial pressure and electrocardiogram were recorded. A 7.5 Fr Swan-Ganz catheter was advanced to the level of the main pulmonary artery to record pulmonary arterial pressure. Cardiac output was measured by a thermodilution technique. A pericardial window (PW) was performed in 3 dogs using thoracoscopy. Hemodynamic variables were recorded before and 15 minutes after injection of lidocaine (1.5 mg/kg) and bupivacaine (1.5 mg/kg) into the pleural space in the control group and in the pericardial space for the PW group. A randomized-block ANOVA for repeated measures was used to evaluate the effect of local anesthetic administration on hemodynamic and electrophysiologic variables in dogs with a pericardectomy. RESULTS Each dog maintained sinus rhythm. Infusion of local anesthetic induced a significant increase in right ventricular diastolic pressure (P = .002) and a significant decrease in stroke volume (P = .047) in both groups; however, the effects were not significantly different between groups. CONCLUSIONS Infusion of lidocaine and bupivacaine, either intrapleural or in the pericardial space, had a mild detrimental effect on cardiac output. CLINICAL RELEVANCE Intrapleural administration of lidocaine and bupivacaine at a therapeutic dose can be used safely in healthy dogs with a pericardectomy.
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Weinberg G, Paisanthasan C, Feinstein D, Hoffman W. The effect of bupivacaine on myocardial tissue hypoxia and acidosis during ventricular fibrillation. Anesth Analg 2004; 98:790-5, table of contents. [PMID: 14980938 DOI: 10.1213/01.ane.0000096259.89137.00] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Previously we observed that during bupivacaine-induced circulatory collapse, myocardial tissue pH declined more slowly than expected. Here we evaluated the effect of bupivacaine on myocardial acidosis induced by ventricular fibrillation. Sixteen dogs were anesthetized with 1.5% end-tidal isoflurane, the chest was opened, and a probe that measured oxygen pressure (PmO(2)), carbon dioxide pressure, pH, and temperature was inserted into myocardial tissue. After baseline measures, each dog received either 10 mg/kg bupivacaine (n = 8) or a sham saline treatment (n = 8). Three minutes later ventricular fibrillation was initiated electrically, and the rate of change in PmO(2) and pH during ventricular fibrillation was measured. Baseline physiological measures were similar in the two groups of dogs. During ventricular fibrillation there was a rapid decrease in PmO(2), and the rate of decrease was not different between sham- and bupivacaine-treated dogs. Tissue pH decreased during ventricular fibrillation, and the rate of decrease was 4 times faster in sham- compared with bupivacaine-treated dogs (P < 0.05). These results show that bupivacaine attenuated myocardial tissue acidosis during ventricular fibrillation. This potentially beneficial effect may be a result of bupivacaine's ability to inhibit myocardial lactate and carbon dioxide production. This suggests a potential clinical application of bupivacaine for myocardial preservation. IMPLICATIONS In this animal study pretreatment with bupivacaine attenuated the progression of myocardial acidosis during ventricular fibrillation. The dogs regained normal hemodynamic variables after lipid infusion. The findings suggest such that bupivacaine may protect the heart against ischemic acidosis.
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Affiliation(s)
- Guy Weinberg
- Department of Anesthesiology, University of Illinois at Chicago College of Medicine and the Chicago VA Hospital Westside Division, Chicago, Illinois 60612, USA.
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Boccara G, Eliet J, Pouzeratte Y, Mann C, Colson P. Pre-emptive lidocaine inhibits arterial vasoconstriction but not vasopressin release induced by a carbon dioxide pneumoperitoneum in pigs. Br J Anaesth 2003; 90:343-8. [PMID: 12594149 DOI: 10.1093/bja/aeg080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We assessed the preventive effects of i.v. or i.p. lidocaine administration on increases in vascular resistance produced by carbon dioxide pneumoperitoneum and related this to vasopressin release. METHODS Carbon dioxide pneumoperitoneum (14 mm Hg intra-abdominal pressure) was performed in 32 anaesthetized young pigs and monitored using a pulmonary artery catheter. Animals received lidocaine 0.5% (0.5 mg kg(-1)) i.v. (n=9) or 2 ml kg(-1) i.p. (n=9) or saline (n=5) 15 min before the pneumoperitoneum and were compared with a control group (n=9). RESULTS I.V. and i.p. lidocaine inhibited increases in mean systemic vascular resistance induced by the pneumoperitoneum [2109 (SD 935) and 2282 (895), respectively, vs 3013 (1067) dyne s(-1) cm(-5) in the control group]. Cardiac output was increased. Plasma lidocaine concentrations were threefold higher after i.p. administration than after i.v. administration. After pneumoperitoneum insufflation, plasma lysine-vasopressin concentrations increased in all groups (control 74%, saline 65%, i.p. lidocaine 57%, i.v. lidocaine 74%). CONCLUSIONS I.V. and i.p. lidocaine blunted systemic vascular responses to carbon dioxide pneumoperitoneum in pigs, but without influencing vasopressin release.
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Affiliation(s)
- G Boccara
- Department of Anaesthesiology and Critical Care DAR-B, University Hospital of Montpellier, France.
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Effects of bupivacaine and lidocaine on cardiac function in awake and pentobarbital-anesthetized rats. J Anesth 1997; 11:38-43. [DOI: 10.1007/bf02480003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/1996] [Accepted: 05/24/1996] [Indexed: 10/24/2022]
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Hemodynamic Responses to an Epinephrine Test Dose in Adults During Epidural or Combined Epidural-General Anesthesia. Anesth Analg 1996. [DOI: 10.1213/00000539-199607000-00017] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Liu SS. Hemodynamic responses to an epinephrine test dose in adults during epidural or combined epidural-general anesthesia. Anesth Analg 1996; 83:97-101. [PMID: 8659773 DOI: 10.1097/00000539-199607000-00017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The efficacy of an epinephrine test dose during epidural and combined epidural-general anesthesia is unknown. Thirty-two patients were randomized to receive 2% lidocaine at either a high (25 mL) or low (12 mL) thoracic level of epidural anesthesia followed by general anesthesia with 1 minimum alveolar anesthetic concentration nitrous oxide and isoflurane. A 15-micrograms epinephrine test dose was intravenously administered prior to placement of the lumbar epidural catheter, 20 min after initiation of epidural anesthesia, and after 10 min of stable end-tidal concentrations of general anesthesia. Only high thoracic levels (T-5) of epidural anesthesia reduced the peak systolic blood pressure response to epinephrine (34 +/- 17 vs 18 +/- 11 mm Hg, control versus epidural stage; P < 0.05) and reduced the peak heart rate response when combined with general anesthesia (31 +/- 11 vs 15 +/- 8 bpm; P < 0.05). Incidences of identification of intravascular injection from hemodynamic responses were similarly reduced for systolic blood pressure (100% vs 44%) and heart rate (100% vs 38%). The standard 15-micrograms epinephrine test dose is unaffected by low thoracic levels of epidural anesthesia, but may have decreased sensitivity for detection of intravascular injection during high thoracic levels of epidural anesthesia, especially during general anesthesia.
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Affiliation(s)
- S S Liu
- Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA 98111, USA
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Fujita Y, Kimura K, Mihira M, Yasukawa T. Decreased coronary blood flow is not responsible for myocardial dysfunction during bupivacaine-induced cardiotoxicity. Acta Anaesthesiol Scand 1996; 40:216-21. [PMID: 8848921 DOI: 10.1111/j.1399-6576.1996.tb04422.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although previous studies have shown that bupivacaine produces a dose-dependent vasoconstriction, the possible effects of decreased coronary blood flow on myocardial dysfunction during bupivacaine-induced cardiotoxicity have not been investigated. METHODS We carried out the present study using the in situ beating hearts of six beagles. An autoperfusion circuit was established from the left carotid artery to the anterior descending coronary artery (LAD). Its blood flow (QLAD) was measured with an electromagnetic flow meter, and myocardial oxygen consumption was calculated using Fick's principle. Regional myocardial function (systolic shortening: %SS, post-systolic shortening: %PSS) of the LAD-supplied region was evaluated by the sonomicrometric technique. While saline or bupivacaine (10 micrograms/ml) was continuously infused into the LAD in a crossover design, the effects of a vehicle (baseline), acetylcholine (1 and 3 micrograms/min), nitroglycerin (10 micrograms/min) and adenosine (10 micrograms/min), on coronary haemodynamics and regional myocardial function were evaluated. RESULTS Bupivacaine caused a decrease in QLAD and regional myocardial dysfunction (a decrease in %SS and an increase in %PSS) at the baseline. While acetylcholine and adenosine increased QLAD with intracoronary bupivacaine-infusion, regional myocardial dysfunction was not reversed. There was a positive correlation between regional myocardial oxygen consumption and %SS in the whole study. CONCLUSIONS The results of this study indicate that the decrease in QLAD during bupivacaine-induced myocardial toxicity is not responsible for regional myocardial dysfunction, and, moreover, that it parallels a decrease in myocardial oxygen demand.
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Affiliation(s)
- Y Fujita
- Department of Anesthesiology, Kawasaki Medical School, Kurashiki-City, Japan
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Abstract
Amrinone has been shown to have therapeutic effects on bupivacaine-induced cardiovascular toxicity, but its exact effects on the heart are not well understood. This study evaluated the regional myocardial effect of amrinone on bupivacaine-induced cardiovascular toxicity in in situ beating hearts in 10 dogs using a selective coronary perfusion and sonomicrometry. In the control group, bupivacaine was administered into the left anterior descending coronary artery (LAD) for 15 min at four steps: baseline, step 1, step 2 and step 3, (calculated LAD plasma concentrations; 0, 5, 5 and 10 mu g center dot ml-1, respectively). In the amrinone group, amrinone (5 mu g center dot ml-1) was simultaneously infused at steps 2 and 3 in addition to bupivacaine infusions. Regional myocardial function of the LAD supplied area was evaluated by analysis of the left ventricular pressure-segment length loop. In the control group, systolic shortening decreased from the baseline (10.5 +/- 1.3%, mean +/- SEM) to step 3 (0.1 +/- 1.3%), and post-systolic shortening increased from the baseline (18.0 +/- 3.7%) to step 3 (52.3 +/- 5.5%) dose-dependently. In contrast, with amrinone infusion at steps 2 and 3, both variables returned to near baseline values. These results indicate that amrinone reverses bupivacaine-induced regional myocardial dysfunction.
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Affiliation(s)
- Y Fujita
- Department of Anesthesiology, Kawasaki Medical School, Kurashiki-City, Okayama, Japan
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