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Neurological and histological outcomes after subarachnoid injection of a liposomal bupivacaine suspension in pigs: a pilot study. Br J Anaesth 2019; 122:379-387. [DOI: 10.1016/j.bja.2018.10.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 11/16/2022] Open
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Wang T, Hurwitz O, Shimada SG, Tian D, Dai F, Zhou J, Ma C, LaMotte RH. Anti-nociceptive effects of bupivacaine-encapsulated PLGA nanoparticles applied to the compressed dorsal root ganglion in mice. Neurosci Lett 2018; 668:154-158. [PMID: 29355697 DOI: 10.1016/j.neulet.2018.01.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/05/2018] [Accepted: 01/16/2018] [Indexed: 11/24/2022]
Abstract
Bupivacaine is a commonly used local anesthetic in postoperative pain management. We evaluated the effects of a prolonged, local delivery of bupivacaine on pain behavior accompanying a chronic compression of the dorsal root ganglion (CCD) - an animal model of radicular pain. Poly(lactide-coglycolide) (PLGA) nanoparticles encapsulating bupivacaine were injected unilaterally into the L3 and L4 DRGs of mice just before producing CCD by implanting a stainless-steel rod in the intervertebral foramen of each ganglion. Behavioral sensitivity to punctate mechanical stimuli (Von Frey filaments) of different forces of indentation, delivered to each hind paw, was measured before and on subsequent days of testing after the CCD. Nanoparticles were spherical in morphology and 150 ± 10 nm in diameter. Bupivacaine was steadily released as measured in vitro over 35 days. A dye that was encapsulated in the nanoparticles was found in the intact DRG after 2 weeks. CCD alone or with injection of blank (control) nanoparticles produced a behavioral hypersensitivity to the punctate stimuli on the ipsilateral paw without affecting sensitivity on the contralateral, over a period of 7-14 days. The hypersensitivity was manifested as an increased incidence of paw-withdrawal to indentation forces normally below threshold (allodynia) and an increased shaking to a filament force that always elicited withdrawal prior to CCD (hyperalgesia). In contrast, nanoparticles with bupivacaine prevented any manifestation of allodynia or hyperalgesia on the ipsilateral hind paw while leaving normal nociceptive responses largely intact on both hind paws. CCD induced behavioral hypersensitivity to nociceptive stimuli is known to be associated with a hyperexcitability of sensory neurons originating in the compressed ganglion. We hypothesize that bupivacaine-loaded PLGA nanoparticles may prevent the occurrence of this neuronal hyperexcitability without reducing the nociceptive information normally conducted from the periphery to the central nervous system. The slow, sustained delivery of bupivacaine by nanoparticles may provide a means of preventing the occurrence of postoperative neuronal hyperexcitability that could develop into chronic neuropathic pain.
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Affiliation(s)
- Tao Wang
- Department of Anatomy, Histology and Embryology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, 06520-8051, USA
| | - Olivia Hurwitz
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, 06520-8051, USA
| | - Steven G Shimada
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, 06520-8051, USA
| | - Daofeng Tian
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Feng Dai
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, 06520-8051, USA
| | - Jiangbing Zhou
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
| | - Chao Ma
- Department of Anatomy, Histology and Embryology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, 06520-8051, USA.
| | - Robert H LaMotte
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, 06520-8051, USA.
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Springer BD, Mason JB, Odum SM. Systemic Safety of Liposomal Bupivacaine in Simultaneous Bilateral Total Knee Arthroplasty. J Arthroplasty 2018; 33:97-101. [PMID: 28844768 DOI: 10.1016/j.arth.2017.07.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/18/2017] [Accepted: 07/25/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Intraoperative periarticular injections (PAIs) with local anesthetic are an important component of multimodal pain control in total joint arthroplasty. Liposomal bupivacaine is an extended-release formulation of bupivacaine designed to provide extended pain relief, approved for use in a single surgical site. The systemic safety profile for use in simultaneous bilateral TKA (bTKA) with a full dose in each knee has not been evaluated. The purpose of this study was to determine the safety and pharmacokinetics of bilateral full-dose PAI liposomal bupivacaine in the blood collected in patients undergoing simultaneous bTKA. METHODS In this prospective study, patients had an identical PAI consisting of 20 cc of liposomal bupivacaine (266 mg), 30 cc of 0.25% bupivacaine (75 mg) with epinephrine, and 10 cc of normal saline injected into each knee during bTKA. Blood samples were collected at predefined intervals until patient discharge. No exogenous bupivacaine was administered. Pharmacokinetic evaluations were subsequently performed and compared to bupivacaine toxicity levels. Patients were monitored for adverse events related to anesthetic toxicity (cardiac and neurologic). RESULTS Fifteen patients (mean age, 60.7 years; range, 57-64 years) were enrolled in the study. The mean peak level (Cmax) was 0.8 μg/mL (range, 0.4-1.2 μg/mL). All patients were well below the reported systemic cardiac and toxicity levels reported as 2-4 μg/mL. There were no reported cardiac and neurotoxic events in any patients. CONCLUSION The use of full-dose PAI with liposomal bupivacaine placed into each knee during simultaneous bTKA is safe with systemic bupivacaine levels well below reported cardiac and neurotoxic levels.
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Cereda CMS, Guilherme VA, Alkschbirs MI, de Brito Junior RB, Tofoli GR, Franz-Montan M, de Araujo DR, de Paula E. Liposomal butamben gel formulations: toxicity assays and topical anesthesia in an animal model. J Liposome Res 2016; 27:74-82. [DOI: 10.3109/08982104.2016.1160924] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Cintia Maria Saia Cereda
- Department of Biochemistry and Tissue Biology, Institute of Biology, State University of Campinas, Campinas, São Paulo, Brazil,
| | - Viviane Aparecida Guilherme
- Department of Biochemistry and Tissue Biology, Institute of Biology, State University of Campinas, Campinas, São Paulo, Brazil,
| | - Melissa Inger Alkschbirs
- Department of Physical Chemistry, Institute of Chemistry, State University of Campinas, Campinas, São Paulo, Brazil,
| | - Rui Barbosa de Brito Junior
- Department of Molecular Biology, São Leopoldo Mandic Dental Research Institute, Campinas, São Paulo, Brazil,
| | - Giovana Radomille Tofoli
- Department of Molecular Biology, São Leopoldo Mandic Dental Research Institute, Campinas, São Paulo, Brazil,
| | - Michelle Franz-Montan
- Department of Physiological Sciences, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil, and
| | | | - Eneida de Paula
- Department of Biochemistry and Tissue Biology, Institute of Biology, State University of Campinas, Campinas, São Paulo, Brazil,
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Cereda CMS, Franz-Montan M, da Silva CMG, Casadei BR, Domingues CC, Tofoli GR, de Araujo DR, de Paula E. Transdermal delivery of butamben using elastic and conventional liposomes. J Liposome Res 2013; 23:228-34. [DOI: 10.3109/08982104.2013.796975] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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de Paula E, Cereda CMS, Fraceto LF, de Araújo DR, Franz-Montan M, Tofoli GR, Ranali J, Volpato MC, Groppo FC. Micro and nanosystems for delivering local anesthetics. Expert Opin Drug Deliv 2012; 9:1505-24. [DOI: 10.1517/17425247.2012.738664] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Local Neurotoxicity and Myotoxicity Evaluation of Cyclodextrin Complexes of Bupivacaine and Ropivacaine. Anesth Analg 2012; 115:1234-41. [DOI: 10.1213/ane.0b013e318266f3d9] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Weiniger CF, Golovanevski L, Domb AJ, Ickowicz D. Extended release formulations for local anaesthetic agents. Anaesthesia 2012; 67:906-16. [PMID: 22607613 DOI: 10.1111/j.1365-2044.2012.07168.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Systemic toxicity through overdose of local anaesthetic agents is a real concern. By encapsulating local anaesthetics in biodegradable carriers to produce a system for prolonged release, their duration of action can be extended. This encapsulation should also improve the safety profile of the local anaesthetic as it is released at a slower rate. Work with naturally occurring local anaestheticss has also shown promise in the area of reducing systemic and neurotoxicity. Extended duration local anaesthetic formulations in current development or clinical use include liposomes, hydrophobic based polymer particles such as Poly(lactic-co-glycolic acid) microspheres, pasty injectable and solid polymers like Poly(sebacic-co-ricinoleic acid) P(SA:RA) and their combination with synthetic and natural local anaesthetic. Their duration of action, rationale and limitations are reviewed. Direct comparison of the different agents is limited by their chemical properties, the drug doses encapsulated and the details of in vivo models described.
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Affiliation(s)
- C F Weiniger
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Centre, Jerusalem, Israel.
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Tofoli GR, Cereda CMS, Araújo DR, Franz-Montan M, Groppo FC, Quaglio D, Pedrazzoli Junior J, Calafatti SA, Barros FAP, de Paula E. Pharmacokinetic study of liposome-encapsulated and plain mepivacaine formulations injected intra-orally in volunteers. J Pharm Pharmacol 2011; 64:397-403. [DOI: 10.1111/j.2042-7158.2011.01425.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Objectives
The pharmacokinetics of commercial and liposome-encapsulated mepivacaine (MVC) injected intra-orally in healthy volunteers was studied.
Methods
In this double blind, randomized cross-over study, 15 volunteers received, at four different sessions, 1.8 ml of the following formulations: 2% MVC with 1 : 100 000 epinephrine (MVC2%EPI), 3% MVC (MVC3%), 2% and 3% liposome-encapsulated MVC (MVC2%LUV and MVC3%LUV). Blood samples were collected pre dose (0 min) and at 15, 30, 45, 60, 90, 120, 180, 240, 300, 360 min after injections. Liquid chromatography-tandem mass spectrometry was used to quantify plasma MVC concentrations.
Results
Pharmacokinetic analysis showed that the maximum plasma concentration (Cmax) and the areas under the curves (AUC0–360 and AUC0–∞) after MVC2%LUV and MVC2%EPI injections were smaller (P < 0.05) than the equivalent figures for MVC3% and MVC3%LUV. The time to maximum plasma concentration (Tmax) and the half-life of elimination (t½beta) obtained after the treatment with MVC2%LUV, MVC2%EPI, MVC3% and MVC3%LUV presented no statistically significant differences (P > 0.05). Cmax, AUC0–360 and AUC0-∞ after injection of the 2% formulations (MVC2%LUV and MVC2%EPI) did not exhibit statistically significant differences (P > 0.05). The pharmacokinetics of MVC2%LUV were comparable to the pharmacokinetics of MVC2%EPI.
Conclusion
The liposomal formulation of 2% MVC exhibits similar systemic absorption to the local anesthetic with vasoconstrictor.
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Affiliation(s)
| | - Cíntia M S Cereda
- Department of Biochemistry, State University of Campinas, Institute of Biology, Campinas, São Paulo, Brazil
| | | | - Michelle Franz-Montan
- Department of Biochemistry, State University of Campinas, Institute of Biology, Campinas, São Paulo, Brazil
| | - Francisco Carlos Groppo
- Piracicaba Dental School, Department of Physiological Sciences, State University of Campinas, Piracicaba, São Paulo, Brazil
| | - Daiane Quaglio
- CORE, Laboratory of Clinical Analysis, Bragança Paulista, São Paulo, Brazil
| | | | | | | | - Eneida de Paula
- Department of Biochemistry, State University of Campinas, Institute of Biology, Campinas, São Paulo, Brazil
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Richard BM, Ott LR, Haan D, Brubaker AN, Cole PI, Nelson KG, Ross PE, Rebelatto MC, Newton PE. The safety and tolerability evaluation of DepoFoam bupivacaine (bupivacaine extended-release liposome injection) administered by incision wound infiltration in rabbits and dogs. Expert Opin Investig Drugs 2011; 20:1327-41. [DOI: 10.1517/13543784.2011.611499] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Weiniger CF, Golovanevski M, Sokolsky-Papkov M, Domb AJ. Review of prolonged local anesthetic action. Expert Opin Drug Deliv 2010; 7:737-52. [PMID: 20408748 DOI: 10.1517/17425241003767383] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE OF THE FIELD Pain following surgery is often treated by local anesthetic agents. Duration of the analgesia can be extended safely following administration of encapsulated large doses of local anesthetic agents. AREAS COVERED IN THIS REVIEW This review considers formulations used for encapsulation of local anesthetic agents for prolonged anesthesia effect. All studies describing encapsulation of a commercial local anesthetic agent for providing prolonged analgesia were considered using the NCBI Medline site. of local anesthetic, prolonged anesthesia, polymers and liposomes were entered in order to retrieve appropriate articles and reviews from 1966 to 2010, with emphasis on the last 10 years. Reference pages were searched manually for other relevant articles. The topics covered include an overview of local anesthetic agents and a review of local anesthetic carrier agents, with emphasis on liposomes and polymer carriers. Articles were limited to the English language. WHAT THE READER WILL GAIN The current research areas for prolongation of local anesthetic effect are evaluated, along with their limitations. Each topic has been summarized, and the review has attempted to cover all current laboratory and clinical studies in a simple manner that should also be useful for readers without a pharmacology background. The direction of research is promising and exciting, and this review should be a useful up-to-date reference. TAKE HOME MESSAGE Many formulations including polymer and liposome carriers have facilitated prolonged local anesthetic action for several days, although few clinical studies have been performed. This field promises a safe way to deliver local anesthetics for effect far beyond that of commercially available agents, with potential cost and health benefits for patients suffering chronic or postoperative pain.
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Affiliation(s)
- Carolyn F Weiniger
- Hadassah Hebrew University Medical Center, Department of Anesthesiology and Critical Care Medicine, Jerusalem, POB 12000, Israel.
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Tomoyasu Y, Yasuda T, Maeda S, Higuchi H, Miyawaki T. Liposome-encapsulated midazolam for oral administration. J Liposome Res 2010; 21:166-72. [DOI: 10.3109/08982104.2010.498002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tofoli GR, Cereda CM, Groppo FC, Volpato MC, Franz-Montan M, Ranali J, de Araújo DR, de Paula E. Efficacy of liposome-encapsulated mepivacaine for infiltrative anesthesia in volunteers. J Liposome Res 2010; 21:88-94. [DOI: 10.3109/08982104.2010.483596] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wiziack Zago PM, Baroni DB, Groppo FC, de Paula E, Ranali J, Volpato MC. Anesthetic efficacy of liposomal prilocaine in maxillary infiltration anesthesia. J Liposome Res 2010; 21:81-7. [DOI: 10.3109/08982101003754393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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de Araujo DR, Cereda CMS, Brunetto GB, Vomero VU, Pierucci A, Neto HS, de Oliveira ALR, Fraceto LF, Braga ADFDA, de Paula E. Pharmacological and local toxicity studies of a liposomal formulation for the novel local anaesthetic ropivacaine. J Pharm Pharmacol 2010. [DOI: 10.1211/jpp.60.11.0005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abstract
This study reports an investigation of the pharmacological activity, cytotoxicity and local effects of a liposomal formulation of the novel local anaesthetic ropivacaine (RVC) compared with its plain solution. RVC was encapsulated into large unilamellar vesicles (LUVs) composed of egg phosphatidylcholine, cholesterol and α-tocopherol (4:3:0.07, mole%). Particle size, partition coefficient determination and in-vitro release studies were used to characterize the encapsulation process. Cytotoxicity was evaluated by the tetrazolium reduction test using sciatic nerve Schwann cells in culture. Local anaesthetic activity was assessed by mouse sciatic and rat infraorbital nerve blockades. Histological analysis was performed to verify the myotoxic effects evoked by RVC formulations. Plain (RVCPLAIN) and liposomal RVC (RVCLUV) samples were tested at 0.125%, 0.25% and 0.5% concentrations. Vesicle size distribution showed liposomal populations of 370 and 130 nm (85 and 15%, respectively), without changes after RVC encapsulation. The partition coefficient value was 132 ± 26 and in-vitro release assays revealed a decrease in RVC release rate (1.5 fold, P < 0.001) from liposomes. RVCLUV presented reduced cytotoxicity (P < 0.001) when compared with RVCPLAIN. Treatment with RVCLUV increased the duration (P < 0.001) and intensity of the analgesic effects either on sciatic nerve blockade (1.4–1.6 fold) and infraorbital nerve blockade tests (1.5 fold), in relation to RVCPLAIN. Regarding histological analysis, no morphological tissue changes were detected in the area of injection and sparse inflammatory cells were observed in only one of the animals treated with RVCPLAIN or RVCluv at 0.5%. Despite the differences between these preclinical studies and clinical conditions, we suggest RVCLUV as a potential new formulation, since RVC is a new and safe local anaesthetic agent.
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Affiliation(s)
- Daniele Ribeiro de Araujo
- Department of Biochemistry, Institute of Biology, State University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Cintia Maria Saia Cereda
- Department of Biochemistry, Institute of Biology, State University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Giovanna Bruschini Brunetto
- Department of Biochemistry, Institute of Biology, State University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Viviane Urbini Vomero
- Department of Anatomy, Institute of Biology, State University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Amauri Pierucci
- Department of Anatomy, Institute of Biology, State University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - Humberto Santo Neto
- Department of Anatomy, Institute of Biology, State University of Campinas - UNICAMP, Campinas, SP, Brazil
| | | | - Leonardo Fernandes Fraceto
- Department of Biochemistry, Institute of Biology, State University of Campinas - UNICAMP, Campinas, SP, Brazil
- Department of Environmental Engineering, State University of São Paulo - UNESP, Sorocaba, SP, Brazil
| | | | - Eneida de Paula
- Department of Biochemistry, Institute of Biology, State University of Campinas - UNICAMP, Campinas, SP, Brazil
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Tofoli GR, Saia Cereda CM, de Araujo DR, Paula ED, Brito Júnior RB, Júnior JP, Meurer E, Proença Barros FA, Groppo FC, Volpato MC, Ranali J. Pharmacokinetic and local toxicity studies of liposome-encapsulated and plain mepivacaine solutions in rats. Drug Deliv 2010; 17:68-76. [DOI: 10.3109/10717540903508995] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cabeça LF, Pickholz M, de Paula E, Marsaioli AJ. Liposome−Prilocaine Interaction Mapping Evaluated through STD NMR and Molecular Dynamics Simulations. J Phys Chem B 2009; 113:2365-70. [DOI: 10.1021/jp8069496] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Luís F. Cabeça
- Institute of Chemistry, UNICAMP, CP 6154, 13083-970 Campinas, SP, Brazil, and Institute of Biology, UNICAMP, CP 6109, 13083-970 Campinas, SP, Brazil
| | - Mónica Pickholz
- Institute of Chemistry, UNICAMP, CP 6154, 13083-970 Campinas, SP, Brazil, and Institute of Biology, UNICAMP, CP 6109, 13083-970 Campinas, SP, Brazil
| | - Eneida de Paula
- Institute of Chemistry, UNICAMP, CP 6154, 13083-970 Campinas, SP, Brazil, and Institute of Biology, UNICAMP, CP 6109, 13083-970 Campinas, SP, Brazil
| | - Anita J. Marsaioli
- Institute of Chemistry, UNICAMP, CP 6154, 13083-970 Campinas, SP, Brazil, and Institute of Biology, UNICAMP, CP 6109, 13083-970 Campinas, SP, Brazil
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Cereda CMS, Tófoli GR, de Brito Junior RB, de Jesus MB, Fraceto LF, Groppo FC, de Araujo DR, de Paula E. Stability and local toxicity evaluation of a liposomal prilocaine formulation. J Liposome Res 2009; 18:329-39. [PMID: 18991066 DOI: 10.1080/08923970802500067] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study reports a physicochemical stability evaluation of a previously reported liposomal prilocaine (PLC(LUV)) formulation (Cereda et al. J. Pharm. Pharmaceut. Sci. 7:235, 2004) before and after steam sterilization as well as its local toxicity evaluation. Prilocaine (PLC) was encapsulated into extruded unilamellar liposomes (LUVs) composed by egg phosphatidylcholine:cholesterol:alfa-tocopherol (4:3:0.07, mole %). Laser light-scattering analysis (p > 0.05) and thiobarbituric acid reaction (p > 0.05) were used to evaluate the liposomes physical (size) and chemical (oxidation) stability, respectively. The prilocaine chemical stability was followed by (1)H-nuclear magnetic resonance. These tests detected no differences on the physicochemical stability of PLC or PLC(LUV), sterilized or not, up to 30 days after preparation (p > 0.05). Finally, the paw edema test and histological analysis of rat oral mucosa were used to assess the possible inflammatory effects of PLC(LUV). PLC(LUV) did not evoke rat paw edema (p > 0.05), and no significant differences were found in histological analysis, when compared to the control groups (p > 0.05). The present work shows that PLC(LUV) is stable for a 30-day period and did not induce significant inflammatory effects both in the paw edema test and in histological analysis, giving supporting evidence for its safety and possible clinical use in dentistry.
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Affiliation(s)
- Cintia M Saia Cereda
- Department of Biochemistry, Institute of Biology, State University of Campinas, Campinas, São Paulo, Brazil
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Li LC, Zhu L, Song JF, Deng JS, Bandopadhyay R, Wurster DE. Effect of Solid State Transition on the Physical Stability of Suspensions Containing Bupivacaine Lipid Microparticles. Pharm Dev Technol 2008; 10:309-18. [PMID: 15926680 DOI: 10.1081/pdt-54475] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Bupivacaine lipid microparticles were prepared and evaluated as a parenteral sustained-release dosage form for postoperative pain management. Bupivacaine free base was incorporated into a molten tristearin matrix and lipid micro-particles were subsequently formed from this molten mixture by a spray-congealing process. A 3% injectable bupivacaine lipid microparticle suspension was prepared by dispersing 30% bupivacaine lipid microparticles in an aqueous medium containing carboxymethylcellulose (CMC), mannitol, and Tween 80. Upon room temperature storage, the fluid suspension gradually changed into a nonflowing semisolid (gelation) as a result of crystal growth of bupivacaine. However, suspensions prepared with bupivacaine lipid microparticles that were previously annealed at an elevated temperature remained fluid upon long-term storage. Differential scanning calorimetry (DSC), x-ray powder diffraction (XRPD), and isoperibol solution calorimetry were used to investigate the changes in the solid-state properties of tristearin and bupivacaine in the lipid microparticles before and after the heat treatment. The DSC and XRPD results indicate that after 24 hours of heating at 40 degrees C, tristearin was completely converted from the unstable alpha form to the stable beta form. Using the isoperibol solution calorimetric method, bupivacaine was found to transform into a more stable form after the lipid microparticles were heated at 60 degrees C for 24 hours. The generation of the unstable solid forms of tristearin and bupivacaine was attributed to the resolidification of both components from the molten mixture during the spray-congealing process.
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Affiliation(s)
- Luk Chiu Li
- Global Parenteral Development and Advanced Drug Delivery, Global Pharmaceutical Research and Development Division, Abbott Laboratories, 100 Abbot Park Rd., Bldg. AP4, Dept. R43D, Abbott Park, IL 60064-6075, USA.
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Abstract
Whereas currently available local anesthetics may be suitable for intraoperative and in-hospital postoperative use, long-acting analgesia after outpatient procedures will require new techniques and drugs. Catheter delivery systems are rapidly gaining clinical acceptance and allow for great flexibility in dosing. Encapsulated local anesthetics can provide the slow release of drugs. Novel, long-acting local anesthetics are being investigated but are not yet ready for clinical use. In addition to the effects on the sodium channel, other actions of these novel compounds need to be explored, because both beneficial and detrimental effects may be induced with these compounds.
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Affiliation(s)
- J Lee White
- Department of Anesthesiology, University of Virginia Health System, Box 800710, Charlottesville, VA 22908, USA
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de Araujo DR, Cereda CMS, Brunetto GB, Pinto LMA, Santana MHA, de Paula E. Encapsulation of mepivacaine prolongs the analgesia provided by sciatic nerve blockade in mice. Can J Anaesth 2004; 51:566-72. [PMID: 15197119 DOI: 10.1007/bf03018399] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Liposomal formulations of local anesthetics (LA) are able to control drug-delivery in biological systems, prolonging their anesthetic effect. This study aimed to prepare, characterize and evaluate in vivo drug-delivery systems, composed of large unilamellar liposomes (LUV), for bupivacaine (BVC) and mepivacaine (MVC). METHODS BVC and MVC hydrochloride were encapsulated into LUV (0.4 micro m) composed of egg phosphatidylcholine, cholesterol and alpha-tocopherol (4:3:0.07 molar ratio) to final concentrations of 0.125, 0.25, 0.5% for BVC and 0.5, 1, 2% for MVC. Motor function and antinociceptive effects were evaluated by sciatic nerve blockade induced by liposomal and plain formulations in mice. RESULTS Liposomal formulations modified neither the intensity nor the duration of motor blockade compared to plain solutions. Concerning sensory blockade, liposomal BVC (BVC(LUV)) showed no advantage relatively to the plain BVC injection while liposomal MVC (MVC(LUV)) improved both the intensity (1.4-1.6 times) and the duration of sensory blockade (1.3-1.7 times) in comparison to its plain solution (P < 0.001) suggesting an increased lipid solubility, availability and controlled-release of the drug at the site of injection. CONCLUSION MVC(LUV) provided a LA effect comparable to that of BVC. We propose MVC(LUV) drug delivery as a potentially new therapeutic option for the treatment of acute pain since the formulation enhances the duration of sensory blockade at lower concentrations than those of plain MVC.
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Affiliation(s)
- Daniele R de Araujo
- Department of Biochemistry, Institute of Biology, State University of Campinas, Sao Paulo, Brazil
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Toongsuwan S, Li LC, Erickson BK, Chang HC. Formulation and characterization of bupivacaine lipospheres. Int J Pharm 2004; 280:57-65. [PMID: 15265547 DOI: 10.1016/j.ijpharm.2004.04.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2003] [Revised: 04/29/2004] [Accepted: 04/29/2004] [Indexed: 10/26/2022]
Abstract
Bupivacaine lipospheres were prepared as a parenteral sustained-release system for post-operative pain management. Bupivacaine free base was incorporated into micron-sized triglyceride solid particles coated with phospholipids, which were formed via a hot emulsification and cold resolidification process. The bupivacaine liposphere dispersions were characterized with respect to drug loading, particle-size distribution, and morphology. Gelation of the fluid liposphere dispersions was observed at different time intervals upon storage. The type of phospholipids used in the formulation was found to have a major impact on the gelation of the dispersion. The use of synthetic phospholipids instead of the natural phospholipids in the formulation yielded bupivacaine liposphere dispersions exhibiting prolonged gelation time. The addition of a hydrophilic cellulosic polymer can further improve the physical stability of the dispersion.
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Affiliation(s)
- Siriporn Toongsuwan
- Global Pharmaceutical Research and Development, Abbott Laboratories, 100 Abbott Park Rd., Bldg. AP4, Dept. R43D, Abbott Park, IL 60064-6075, USA.
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Abstract
UNLABELLED Early preclinical work demonstrated the potential role of spinal benzodiazepine pharmacology in regulating spinal nociceptive transmission. We review this preclinical activity and the evolving implementation of intrathecal midazolam in humans for pain management. Important elements in this development for use in humans are issues pertinent to safety and the preclinical reports that have increased our understanding of intrathecal midazolam toxicity. We seek to emphasize the time course of these studies and how they merged to provide enabling data that drove the clinical implementation. In the case of midazolam, we point to the potential issues that arose when preclinical safety data were unreasonably ignored and how consideration of preclinical safety data can serve to facilitate drug development by demonstrating reasonable safety profiles that document the minimal degree of potential risk to the patient. Issues that are of continuing relevance to the use of intrathecal midazolam, including issues of formulation and kinetics, are considered. IMPLICATIONS The intrathecal use of midazolam has evolved over 20 years though a combination of preclinical and clinical investigations. We review the time course of this development to define critical elements that should be pursued in reducing the risk associated with the clinical use of a novel spinal drug.
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Affiliation(s)
- Tony L Yaksh
- Department of Anesthesiology, University of California, San Diego, La Jolla, California
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25
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Abstract
The ability to provide an extended duration of analgesia of days following a single injection without the need for catheters, pumps and infusion systems would be a great benefit in acute and chronic pain. Exciting progress is being made in our ability to combine local anaesthetics with liposomes and polymer microspheres. These interesting formulations in animal models have allowed up to 4 days of analgesia. Their use clinically will be a great advance which could possibly occur in the near future.
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Affiliation(s)
- Stuart A Grant
- Department of Anesthesiology, Duke Medical Center, Durham, NC 27710, USA
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Malinovsky JM, Le Corre P, Meunier JF, Chevanne F, Pinaud M, Leverge R, Legros F. A dose-response study of epidural liposomal bupivacaine in rabbits. J Control Release 1999; 60:111-9. [PMID: 10370175 DOI: 10.1016/s0168-3659(99)00062-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Liposomes are drug delivery systems used to prolong local effects of bupivacaine. We studied the relationships between motor and hemodynamic changes and epidural doses of plain bupivacaine (P) and liposomal bupivacaine (L) in rabbits equipped with chronical lumbar epidural and femoral arterial catheters. Liposomal (phosphatidylcholine-cholesterol) suspensions contained 20 mg ml-1 of lipid, and different doses of bupivacaine (Lipo 7.5=7.5-; Lipo 3.7=3. 75-; Lipo 2.5=2.5-; Lipo 1.2=1.25-; and Lipo 0.7=0.65-mg of bupivacaine per ml). Forty rabbits were randomly assigned to five groups to receive epidural anesthesia (1 ml) as follows: Groups I to V received 0.65 to 7.5 mg of bupivacaine as P then as L. Release rate of bupivacaine from liposome was significantly slower using Lipo 3.7 than after Lipo 2.5 (Td was 3.9 h and 1.7 h respectively). Increasing the doses of L and P resulted in faster onset time for complete motor blockade and in a prolonged duration of motor effects. Liposomal formulation appears to be a powerful delivery system to prolong the motor effects of bupivacaine since E50 was lower and Emax higher than after the use of plain solution (E50 4.49+/-1.81 mg and Emax 152+/-40 min for P; and E50 2.61+/-0.23 mg and Emax 202+/-9 min for L). Hemodynamic changes were linearly related to doses of bupivacaine injected. The best bupivacaine-to-lipid ratio to prolong motor effects using our model was 3.75 mg and 20.0 mg respectively (Lipo 3.7).
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Affiliation(s)
- J M Malinovsky
- Laboratoire d'Anesthésie et Chirurgie Expérimentale, Université de Nantes, Nantes, France.
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