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Bupivacaine toxicity

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https://www.readbyqxmd.com/read/29406174/high-dose-versus-low-dose-local-anaesthetic-for-transversus-abdominis-plane-block-post-caesarean-delivery-analgesia-a-meta-analysis
#1
REVIEW
S C Ng, A S Habib, S Sodha, B Carvalho, P Sultan
BACKGROUND: The optimal local-anaesthetic (LA) dose for transversus-abdominis-plane (TAP) block is unclear. In this meta-analysis, we aimed to determine whether TAP blocks for Caesarean delivery (CD) with low-dose (LD) LA demonstrated non-inferiority in terms of analgesic efficacy, compared with high-dose (HD) LA. METHODS: A literature search was performed for randomised controlled trials examining the analgesic efficacy of TAP blocks vs control after CD. The different dosing used in these studies was classified as HD or LD (bupivacaine equivalents >50 or ≤50 mg per block side, respectively)...
February 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29356774/the-mechanisms-underlying-lipid-resuscitation-therapy
#2
Michael R Fettiplace, Guy Weinberg
The experimental use of lipid emulsion for local anesthetic toxicity was originally identified in 1998. It was then translated to clinical practice in 2006 and expanded to drugs other than local anesthetics in 2008. Our understanding of lipid resuscitation therapy has progressed considerably since the previous update from the American Society of Regional Anesthesia and Pain Medicine, and the scientific evidence has coalesced around specific discrete mechanisms. Intravenous lipid emulsion therapy provides a multimodal resuscitation benefit that includes both scavenging (eg, the lipid shuttle) and nonscavenging components...
February 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29356773/the-third-american-society-of-regional-anesthesia-and-pain-medicine-practice-advisory-on-local-anesthetic-systemic-toxicity-executive-summary-2017
#3
Joseph M Neal, Michael J Barrington, Michael R Fettiplace, Marina Gitman, Stavros G Memtsoudis, Eva E Mörwald, Daniel S Rubin, Guy Weinberg
The American Society of Regional Anesthesia and Pain Medicine's Third Practice Advisory on local anesthetic systemic toxicity is an interim update from its 2010 advisory. The advisory focuses on new information regarding the mechanisms of lipid resuscitation, updated frequency estimates, the preventative role of ultrasound guidance, changes to case presentation patterns, and limited information related to local infiltration anesthesia and liposomal bupivacaine. In addition to emerging information, the advisory updates recommendations pertaining to prevention, recognition, and treatment of local anesthetic systemic toxicity...
February 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29338097/synthesis-of-multifunctional-spirocyclic-azetidines-and-their-application-in-drug-discovery
#4
Alexander Kirichok, Irina Shton, Irina Pishel, Sergey Zozulya, Petro Borysko, Vladimir Kubyshkin, Olha Zaporozhets, Andrei Tolmachev, Pavel Mykhailiuk
Spirocyclic polyfunctional azetidines have been synthesized and validated in drug discovery. Spirocyclic analogue of the anesthetic drug Bupivacaine with 5-times smaller toxicity was developed.
January 16, 2018: Chemistry: a European Journal
https://www.readbyqxmd.com/read/29326848/the-knowledge-of-eye-physicians-on-local-anesthetic-toxicity-and-intravenous-lipid-treatment-questionnaire-study
#5
Aykut Urfalıoğlu, Selma Urfalıoğlu, Gözen Öksüz
Objectives: To evaluate the knowledge of ophthalmologists regarding local anesthesia toxicity syndrome (LATS) and intravenous lipid emulsion used in treatment, and to raise awareness of this issue. Materials and Methods: A questionnaire comprising 14 questions about demographics, local anesthesia (LA) use, toxicity, and treatment methods was administered to ophthalmologists at different hospitals. Results: The study included 104 ophthalmologists (25% residents, 67...
December 2017: Turkish Journal of Ophthalmology
https://www.readbyqxmd.com/read/29295799/profound-prolonged-bradycardia-and-hypotension-after-interscalene-brachial-plexus-block-with-bupivacaine
#6
Mathew Nelson, Alexandra Reens, Lara Reda, David Lee
BACKGROUND: Interscalene brachial plexus blocks have been a routinely performed method of anesthesia for shoulder surgery that decreases the need for general anesthesia, length of stay, and recovery time. We describe a case of bupivacaine toxicity after an interscalene block. CASE REPORT: The patient was a 66-year-old man who presented to our Emergency Department by emergency medical services from an ambulatory surgery center where he had undergone rotator cuff surgery, with bradycardia and hypotension...
December 30, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29284860/effect-of-locally-administered-dexmedetomidine-as-adjuvant-to-levobupivacaine-in-supraclavicular-brachial-plexus-block-double-blind-controlled-study
#7
Bikash Bisui, Swastika Samanta, Sumanta Ghoshmaulik, Amit Banerjee, Tirtha R Ghosh, Suman Sarkar
Context: Brachial plexus block is effective with good postoperative analgesia in upper limb surgery has gained importance as it safe, low cost, and maintains stable hemodynamics intraoperatively. To decrease the onset time and prolong the duration of nerve block bicarbonate, opioids (morphine, fentanyl, etc.), sympathomimetic agents (epinephrine, phenylephrine, etc.), α-2 agonists (clonidine and dexmedetomidine), calcium channel blocker (verapamil), magnesium sulfate, etc., were studied with local anesthetics and their isomers...
October 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29239940/prolonged-duration-local-anesthesia-using-liposomal-bupivacaine-combined-with-liposomal-dexamethasone-and-dexmedetomidine
#8
Alina Y Rwei, Robert T Sherburne, David Zurakowski, Bruce Wang, Daniel S Kohane
BACKGROUND: The relatively short duration of effect of local anesthetics has been addressed by encapsulation in drug delivery systems. Codelivery with a single compound that produces an adjuvant effect on nerve block but without intrinsic local anesthetic properties can further prolong the nerve block effect. Here, we investigated whether codelivery of more than 1 encapsulated adjuvant compound can further enhance nerve blockade. METHODS: Liposomes loaded with bupivacaine (Bup), dexamethasone phosphate (DexP), or dexmedetomidine (DMED) were synthesized and its in vitro drug release profiles were determined...
December 11, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29232206/bupivacaine-indirectly-potentiates-glutamate-induced-intracellular-calcium-signaling-in-rat-hippocampal-neurons-by-impairing-mitochondrial-function-in-cocultured-astrocytes
#9
Yuan Xing, Nan Zhang, Wei Zhang, Lei-Ming Ren
BACKGROUND: Bupivacaine induces central neurotoxicity at lower blood concentrations than cardiovascular toxicity. However, central sensitivity to bupivacaine is poorly understood. The toxicity mechanism might be related to glutamate-induced excitotoxicity in hippocampal cells. METHODS: The intracellular free Ca concentration ([Ca]i), mitochondrial membrane potential, and reactive oxygen species generation were measured by fluorescence and two-photon laser scanning microscopy in fetal rat hippocampal neurons and astrocytes...
December 12, 2017: Anesthesiology
https://www.readbyqxmd.com/read/29232029/the-effects-of-subconjunctival-bupivacaine-lidocaine-and-mepivacaine-on-corneal-sensitivity-in-healthy-horses
#10
Maggie R Jinks, Robin L Fontenot, Robert W Wills, Caroline M Betbeze
OBJECTIVE: To compare the efficacy and duration of effect of three local anesthetics on corneal sensitivity when administered subconjunctivally in horses. ANIMALS STUDIED: Eight healthy adult horses. PROCEDURE: A randomized, masked, crossover study design was used, with a two-week washout period between trials. The subconjunctival space of the randomly selected eye was injected with 0.2 mLs of bupivacaine (0.5%), lidocaine (2%), mepivacaine (2%), or saline...
December 12, 2017: Veterinary Ophthalmology
https://www.readbyqxmd.com/read/29145932/lipid-emulsion-more-than-reversing-bupivacaine-cardiotoxicity-potential-organ-protection
#11
Negar Motayagheni, Sheshanna Phan, Ala Nozari, Anthony Atala
Efforts to develop a treatment for bupivacaine cardiotoxicity led to the discovery that Intralipid, a popular brand of intravenous lipid emulsion, could be used not only as an effective treatment for anesthetic-induced cardiac arrest, but also as a means of reversing many other toxicities. Contradictory data exist regarding the mechanism of action of lipid emulsion, a combination of fatty acids traditionally used in parenteral nutrition. Some researchers attribute the effects to lipophilicity and the individual characteristics of the lipids, while other data demonstrate a direct empowering mechanism through cellular upstream and downstream pathways...
2017: Journal of Pharmacy & Pharmaceutical Sciences: a Publication of the Canadian Society for Pharmaceutical Sciences
https://www.readbyqxmd.com/read/29115971/local-anaesthetics-or-their-combination-with-morphine-and-or-magnesium-sulphate-are-toxic-for-equine-chondrocytes-and-synoviocytes-in-vitro
#12
L M Rubio-Martínez, E Rioja, M Castro Martins, S Wipawee, P Clegg, M J Peffers
BACKGROUND: Chondrotoxic effects of local anaesthetics are well reported in humans and some animal species but knowledge on their toxic effects on synoviocytes or equine chondrocytes or the effects on cellular production of inflammatory cytokines is limited. The purpose of this study was to evaluate the in vitro effects of local anaesthetics, morphine, magnesium sulphate (MgSO4) or their combinations on cell viability and pro-inflammatory cytokine gene expression of equine synoviocytes and chondrocytes...
November 7, 2017: BMC Veterinary Research
https://www.readbyqxmd.com/read/29111148/effects-of-opioid-and-nonopioid-analgesics-on-canine-wheal-formation-and-cultured-human-mast-cell-degranulation
#13
Eric Schmidt-Rondon, Zhenping Wang, Shelle A Malkmus, Anna Di Nardo, Keith Hildebrand, Linda Page, Tony L Yaksh
Mast cell (MC) degranulation has been implicated in the side effect profile of a variety of clinically useful agents. Thus, after intrathecal delivery, formation of space-occupying, meningeally-derived masses may be related to local MC degranulation. We systematically characterized degranulating effects of opioid and nonopioid analgesics on cutaneous flares in the dog and in primary human MC (hMC) cultures. METHODS: Dogs were anesthetized with IV propofol and received intradermal (ID) injections (50μL)...
October 27, 2017: Toxicology and Applied Pharmacology
https://www.readbyqxmd.com/read/29084192/transient-left-ventricular-dysfunction-due-to-coronary-spasm-after-spinal-anesthesia-with-bupivacaine-a-case-report
#14
Waldemar Elikowski, Małgorzata Małek-Elikowska, Marek Słomczyński, Karolina Horbacka, Jarosław Bartkowski, Bartosz Kalawski
Bupivacaine is a long-acting local anesthetic (LA) used for cutaneous infiltration, peripheral nerve blocks, epidural and spinal anesthesia. However, its application may result in cardiovascular complications such as: hypotension, bradycardia, cardiac arrest and toxic myocardial injury. The authors describe a 53-year-old male with a history of cigarette smoking, admitted for an elective inguinal hernia surgery. Before surgery, the patient received subarachnoid injection of bupivacaine (20 mg). After the operation, he developed transient hypotension...
October 23, 2017: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
https://www.readbyqxmd.com/read/29055733/qx-oh-levobupivacaine-fixed-dose-combination-to-provide-a-long-acting-postoperative-pain-of-knee-surgery-in-rodents
#15
WenLing Zhao, Jun Yang, YuJun Zhang, Jin Liu, WenSheng Zhang
Although total knee arthroplasty (TKA) is a commonly performed procedure, anesthetic efficacy in post-surgical pain remains an issue. Exparel (45mM liposome bupivacaine), a relatively long-acting local anesthetic, has shown efficacy in blocking peripheral nerve or periarticular infiltration to achieve better post-TKA analgesia. In the present work, we tested whether a fixed-dose combination of QX-OH (35mM) and levobupivacaine (10mM) (QX-OH/LB) could confer longer-lasting pain relief and reduce periarticular tissue toxicity compared to liposome bupivacaine (45mM) after TKA operation...
January 1, 2018: European Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/29042063/-pharmacokinetic-and-clinical-effects-of-two-bupivacaine-concentrations-on-axillary-brachial-plexus-block
#16
Leonardo H C Ferraro, Alexandre Takeda, Cleber N Barreto, Bernadete Faria, Nilson A Assunção
INTRODUCTION: The risk of systemic bupivacaine toxicity is a persistent problem, which makes its pharmacokinetic study fundamental for regional anesthesia safety. There is little evidence of its influence on plasma peak at different concentrations. The present study compares two bupivacaine concentrations to establish how the concentration affects this drug plasma peak in axillary brachial plexus block. Postoperative latency and analgesia were also compared. METHODS: 30 patients were randomized...
October 14, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28982145/encapsulation-of-ropivacaine-in-a-combined-donor-acceptor-ionic-gradient-liposomal-system-promotes-extended-anesthesia-time
#17
Camila Morais Gonçalves da Silva, Michelle Franz-Montan, Cíntia Elisabeth Gomez Limia, Lígia Nunes de Morais Ribeiro, Mário Antônio Braga, Viviane Aparecida Guilherme, Camila Batista da Silva, Bruna Renata Casadei, Cíntia Maria Saia Cereda, Eneida de Paula
Ropivacaine is a local anesthetic with similar potency but lower systemic toxicity than bupivacaine, the most commonly used spinal anesthetic. The present study concerns the development of a combined drug delivery system for ropivacaine, comprised of two types of liposomes: donor multivesicular vesicles containing 250 mM (NH4)2SO4 plus the anesthetic, and acceptor large unilamellar vesicles with internal pH of 5.5. Both kinds of liposomes were composed of hydrogenated soy-phosphatidylcholine:cholesterol (2:1 mol%) and were prepared at pH 7...
2017: PloS One
https://www.readbyqxmd.com/read/28913485/an-in-vitro-study-of-the-release-capacity-of-the-local-anaesthetics-from-siloxane-matrices
#18
Gabriela Preda, Alexandru Florin Rogobete, Dorel Săndesc, Ovidiu Horea Bedreag, Carmen Alina Cradigati, Mirela Sarandan, Marius Papurica, Sonia Elena Popovici, Monica Dragomirescu
AIMS: In the field of anaesthesia and intensive care, the controlled release systems capable of delivering constantly local anaesthetics are of interest because of the advantages brought to pain management. In this paper we presented the release profiles by usage of siloxane matrices of two common local anaesthetics, lidocaine and bupivacaine, analysed in vitro. METHODS: The siloxane matrices were obtained in accordance with the methods described in the specialized literature, tetraethoxysilane (TEOS) and tetramethoxysilane (TMOS) were used as precursors...
October 2016: Romanian Journal of Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/28844768/systemic-safety-of-liposomal-bupivacaine-in-simultaneous-bilateral-total-knee-arthroplasty
#19
Bryan D Springer, J Bohannon Mason, Susan M Odum
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...
August 1, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28751934/activation-of-p47phox-as-a-mechanism-of-bupivacaine-induced-burst-production-of-reactive-oxygen-species-and-neural-toxicity
#20
Yu-Jie Li, Wei Zhao, Xu-Jiao Yu, Feng-Xian Li, Zi-Ting Liu, Le Li, Shi-Yuan Xu
Bupivacaine has been shown to induce neurotoxicity through inducing excessive reactive oxygen species (ROS), but the underlying mechanism remains unclear. NOX2 is one of the most important sources of ROS in the nervous system, and its activation requires the membrane translocation of subunit p47phox. However, the role of p47phox in bupivacaine-induced neurotoxicity has not been explored. In our in vitro study, cultured human SH-SY5Y neuroblastoma cells were treated with 1.5 mM bupivacaine to induce neurotoxicity...
2017: Oxidative Medicine and Cellular Longevity
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