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Department of Anesthesiology, *Virginia Mason Clinic and
University of Washington, Seattle, Washington;
Medical Research and
Clinical Pharmacokinetics, Purdue Pharma L. P., Stamford;
||Magidom Discovery, LLC, Westport, Connecticut; and
¶Department of Anesthesia, University of Pennsylvania, Philadelphia, Pennsylvania
Address correspondence and reprint requests to Dr. Dan J. Kopacz, Department of Anesthesiology, Virginia Mason Clinic, 1100 Ninth Ave., B2-AN, PO Box 900, Seattle, WA 98111. Address e-mail to anedjk{at}vmmc.org
Biodegradable microcapsules produce an ultra-long duration of local anesthesia. We hypothesized that this duration is caused by the sustained-release of bupivacaine from the microcapsules into the surrounding tissue. Previous studies investigated the pharmacokinetics (PKs) of bupivacaine after release from microcapsules and absorption into the systemic circulation. Microdialysis sampling can determine the PKs of any drug at its site of injection. This study was performed to characterize the PKs of bupivacaine and dexamethasone released from microcapsules at a subcutaneous injection site over a 96-h period in volunteers. Bupivacaine concentrations were compared with clinical variables of local anesthetic blockade. This study demonstrates that bupivacaine is released in a sustained manner from microcapsules, that bupivacaine concentrations increase for 24–34 h after microcapsule injection, and that analgesia parallels the tissue bupivacaine concentration obtained by microdialysis. Analgesia was equally rapid in onset with aqueous and microcapsule bupivacaine (P = 0.23). Analgesia was still present at 78% of microcapsule-injected sites after 96 h, significantly longer than for aqueous bupivacaine (P < 0.001). Mild pruritus was the most common side effect, occurring with 56% of the microcapsule injections. Dexamethasone-containing bupivacaine microcapsules are well tolerated and produce a prolonged duration of skin analgesia. Systemic absorption of bupivacaine produces higher peak plasma levels after aqueous injection than after microcapsule injection, despite the injection of a threefold larger load of bupivacaine in the latter.
IMPLICATIONS: Microcapsules loaded with bupivacaine and dexamethasone and administered by subcutaneous injection produce prolonged cutaneous anesthesia and analgesia. Determination of local tissue pharmacokinetic variables of bupivacaine by microdialysis confirms that the prolonged duration of anesthesia is caused by the extended release characteristics of the microcapsules.
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  J. L. Pedersen, J. Lilleso, N. A. Hammer, M. U. Werner, K. Holte, P. G. Lacouture, and H. Kehlet Bupivacaine in Microcapsules Prolongs Analgesia After Subcutaneous Infiltration in Humans: A Dose-Finding Study Anesth. Analg., September 1, 2004; 99(3): 912 - 918. [Abstract] [Full Text] [PDF]
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