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REGIONAL ANESTHESIA

The Pharmacokinetics and Pharmacodynamics of Bupivacaine-Loaded Microspheres on a Brachial Plexus Block Model in Sheep

Jean-Pierre Estebe, MD^*, Pascal Le Corre, PharmD, PhD, Laure Du Plessis, PharmD, François Chevanne, BS, Guy Cathelineau, DD, PhD, Roger Le Verge, PharmD, PhD, and Claude Ecoffey, MD

*Service d’Anesthésie Réanimation Chirurgicale; Laboratoire de Pharmacie Galénique et Biopharmacie; and Laboratoire des Biomatériaux en Site Osseux, Université de Rennes 1, Rennes, France

Address correspondence and reprint requests to JP Estebe, MD, Service d’Anesthésie Réanimation Chirurgicale 2, Hôpital Hôtel Dieu: 2 rue de l’Hôtel Dieu, 35000, Rennes, France. Address e-mail to jean-pierre.estebe{at}chu-rennes.fr

We evaluated bupivacaine-loaded microspheres (B-Ms) using a brachial plexus block model in sheep. In the first step, pharmacokinetic characterization of 75 mg bupivacaine hydrochloride (B-HCl) (IV infusion and brachial plexus block) was performed (n = 12). In the second step, a brachial plexus block dose response study of B-HCl was performed with 37.5 mg, 75 mg, 150 mg, 300 mg, and 750 mg. As a comparison, evaluations were performed using a 750-mg bupivacaine base (B). In the third step, evaluations of brachial plexus block were performed with B-Ms (750 mg of B as B-Ms) using two formulations, 60/40 and 50/50 (w/w %); drug-free microspheres were also evaluated. Toxicity evaluations were also performed after IV administration of B-HCl (750 mg and 300 mg), B-Ms (750 mg), and drug-free microspheres (30 mL over 1 min). As the B-HCl dose increased, the time of onset of block decreased and the duration of complete motor blockade increased at the expense of an increase in bupivacaine plasma concentrations. The time of maximum concentration appeared to be independent of the B-HCl dose. In brachial plexus block, a 37.5-mg dose of B-HCl did not induce motor blockade whereas a dose of 750 mg of B-HCl was clinically toxic. In the case of IV administration, doses of 300 mg of B-HCl were as toxic as 750 mg of B-HCl. Compared with the 75 mg of B-HCl administration for brachial plexus block, administration of 750 mg of B as B-Ms increased the duration of complete motor blockade without significant difference in maximum concentration. No significant clinical difference between the two formulations of B-Ms was demonstrated. The IV administration of B-Ms was safe. We conclude that the controlled release of bupivacaine from microspheres prolonged the brachial plexus block without obvious toxicity.

IMPLICATIONS: Administration of 750 mg of bupivacaine as loaded-microspheres resulted in prolongation of brachial plexus block in sheep. The peak plasma concentration was not significantly larger than that obtained with 75 mg of plain bupivacaine. The motor blockade was increased more than six times compared with 75 mg plain bupivacaine.

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