Abstract
Glycerin has been used as a drug carrier/depot, but never with local anaesthestics. This study was an attempt to use the slow drug release mechanism to prolong the anaesthetic effects of bupivacaine in epidural block. Twenty-seven adults with cancer pain were prospectively selected according to their primary lesions and problems, but their allocation to study groups was randomized. Group I (n = 13), received 5 ml bupivacaine, 0.125% in normal saline via a previous implanted epidural catheter. When the pain returned to its original intensity, the same amount of the same strength anaesthetic dissolved in 50% glycerin was given via the same catheter. Group II (n = 14) received the same solutions, but in the reverse order. Also five patients in each group received plain 50% glycerin prior to administration of the anaesthetic solutions to serve as controls. The pharmacological effects were assessed by the blinded observers. Analgesia produced with glycerin solution was prolonged compared with the saline solution (12.2 vs 7.2 and 11.6 vs 7.4 hr, P < 0.01). The order of giving the solution did not produce any differences. Plan 50% glycerin did not produce analgesic effects. Neither motor blockade nor other adverse effects or complications were observed in either group. It was concluded that 0.125% bupivacaine in 50% glycerin administered epidurally is not neurotoxic. The prolongation of analgesia observed is attributed to the slow release of bupivacaine from the glycerin base which functions as drug depot. In addition to relief of chronic pain, this novel approach may have other clinical applications such as the relief of labour or postoperative pain.
Résumé
La glycérine sert de vecteur et de réservoir à bien des substances médicamenteuses mais on ne l’a jamais utilisée avec des anesthésiques locaux. Cette étude veut tirer profit du mécanisme de libération retardée pour prolonger les effets de la bupivacaïne pendant le bloc épidural. Vingt-sept adultes souffrant de douleur cancéreuse font partie de cette étude randomisée et prospective. Ils sont distribués en trois groupes. Le groupe I (n = 13) reçoit bupivacaïne 0,125% dans le soluté physiologique 5 ml par un cathéter préalablement implanté. Lorsque la douleur revient à son intensité initiale, on injecte par le cathéter épidural la même quantité et la même concentration de l’anesthésique dissout dans la glycérine 50%. Le groupe II reçoit les mêmes solutions, mais dans l’ordre inverse. Cinq patients de chaque groupe recoivent seulement de la glycérine 50% par la même voie avant l’administration de l’anesthésique et servent ainsi de contrôles. Les effets sont évalués par un observateur neutre. L’analgésie produite par la solution glycérinée dure plus longtemps que la solution préparée avec le soluté physiologique (12,2 vs 7,2 et 11,6 vs 7,4 P < 0,01). L’ordre de l’administration n’a pas d’importance. La glycérine 50% seule n’a pas d’activité analgésique. On n’a pas observé de bloc moteur ni d’effets défavorables dans aucun des groupes. On en conclut que la bupivacaïne 0,125% dans la glycérine 50% ne cause pas de neurotoxicité en administration épidurale. La prolongation de l’effet est attribute au fait que la glycérine, qui agit comme un réservoir, libère lentement son contenu de bupivacaïne. En plus de son efflcacité contre la douleur chronique, on peut entrevoir pour cette modalite therapeutique de nouvelles applications comme le soulagement de la douleur obstétricale et postopératoire.
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King, Hk., Xiao, CS. & Wooten, D.J. Prolongation of epidural bupivacaine analgesia with glycerin. Can J Anaesth 40, 431–434 (1993). https://doi.org/10.1007/BF03009512
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DOI: https://doi.org/10.1007/BF03009512