Local anesthetics transfer relies on pH differences and affinities toward lipophilic compartments

Ultrasound-Guided Suprainguinal Fascia Iliaca Block as Part of Anesthesia Management for Lower Extremity Surgeries: A Single-Center Retrospective Cohort Feasibility Study

Study objective The ultrasound-guided (US-guided) suprainguinal fascia iliaca block (SIFIB) is a regional anesthesia procedure that targets the lumbar plexus. It offers versatility in clinical practice, serving as both a standalone method for adequate pain management and a primary anesthesia option. Our aim was to present clinical insights gained from the application of US-guided SIFIB, whether as a standalone procedure or in conjunction with another block, across various clinical indications for lower extremity surgeries. Methodology Our study is a retrospective cohort analysis designed to identify cases in which the SIFIB was used as a component of the main anesthetic method and to determine the success of the anesthetic method in patients undergoing lower extremity surgery between March 2022 and March 2023 in a tertiary hospital. Data such as block success, perioperative additional analgesic need, patients' demographic details, and block characteristics were obtained from electronic and paper-based patient records and analyzed. Main results  We analyzed data from 16 patients who underwent lower extremity surgeries under SIFIB. Among these, 10 patients received SIFIB as their sole anesthesia method, while six underwent surgery with a combination of sciatic block and SIFIB. Briefly, the types of surgery were amputations, soft tissue excision, revision of knee prostheses, excision of knee tumors, patella implant removal, patellar ligament repair, patellar fracture repair, distal femur fractures (internal fixation), and vascular surgery. Six patients necessitated additional analgesics. No statistically significant differences were observed in demographic details, block onset time, and surgical duration between patients requiring and not requiring sedoanalgesia during surgery (p>0.05). Conclusion For patients planning lower extremity surgery, considering SIFIB alone or combined with a sciatic block as part of anesthesia management is a valid option, offering an alternative to a lumbar plexus block.

Antioxidant activity of lidocaine, bupivacaine, and ropivacaine in aqueous and lipophilic environments: an experimental and computational study

Introduction: Local anesthetics are widely recognized pharmaceutical compounds with various clinical effects. Recent research indicates that they positively impact the antioxidant system and they may function as free radical scavengers. We hypothesize that their scavenging activity is influenced by the lipophilicity of the environment. Methods: We assessed the free radical scavenging capacity of three local anesthetics (lidocaine, bupivacaine, and ropivacaine) using ABTS, DPPH, and FRAP antioxidant assays. We also employed quantum chemistry methods to find the most probable reaction mechanism. The experiments were conducted in an aqueous environment simulating extracellular fluid or cytosol, and in a lipophilic environment (n-octanol) simulating cellular membranes or myelin sheets. Results: All local anesthetics demonstrated ABTS˙⁺ radical scavenging activity, with lidocaine being the most effective. Compared to Vitamin C, lidocaine exhibited a 200-fold higher half-maximal inhibitory concentration. The most thermodynamically favorable and only possible reaction mechanism involved hydrogen atom transfer between the free radical and the -C-H vicinal to the carbonyl group. We found that the antioxidant activity of all tested local anesthetics was negligible in lipophilic environments, which was further confirmed by quantum chemical calculations. Conclusion: Local anesthetics exhibit modest free radical scavenging activity in aqueous environments, with lidocaine demonstrating the highest activity. However, their antioxidant activity in lipophilic environments, such as cellular membranes, myelin sheets, and adipose tissue, appears to be negligible. Our results thus show that free radical scavenging activity is influenced by the lipophilicity of the environment.

How Azide Ion/Hydrazoic Acid Passes Through Biological Membranes: An Experimental and Computational Study

Hydrazoic acid (HN₃) and its deprotonated form azide ion (N₃^-) (AHA) are toxic because they inhibit the cytochrome c oxidase complex IV (CoX IV) embedded in the inner mitochondrial membrane that forms part of the enzyme complexes involved in cellular respiration. Critical to its toxicity is the inhibition of CoX IV in the central nervous system and cardiovascular system. Hydrazoic acid is an ionizable species and its affinity for membranes, and the associated permeabilities, depend on the pH values of aqueous media on both sides of the membranes. In this article, we address the permeability of AHA through the biological membrane. In order to understand the affinity of the membrane for the neutral and ionized form of azide, we measured the octanol/water partition coefficients at pH values of 2.0 and 8.0, which are 2.01 and 0.00034, respectively. Using a Parallel Artificial Membrane Permeability Assay (PAMPA) experiment, we measured the effective permeability through the membrane, which is logP_e - 4.97 and - 5.26 for pH values of 7.4 and pH 8.0, respectively. Experimental permeability was used to validate theoretical permeability, which was estimated by numerically solving a Smoluchowski equation for AHA diffusion through the membrane. We demonstrated that the rate of permeation through the cell membrane of 8.46·10⁴ s^-1 is much higher than the rate of the chemical step of CoX IV inhibition by azide of 200 s^-1. The results of this study show that transport through the membrane does not represent the rate-limiting step and therefore does not control the rate of CoX IV inhibition in the mitochondria. However, the observed dynamics of azide poisoning is controlled by circulatory transport that takes place on a time scale of minutes.

Molecular Dynamics and Structural Studies of Zinc Chloroquine Complexes

Chloroquine (CQ) is a first-choice drug against malaria and autoimmune diseases. It has been co-administered with zinc against SARS-CoV-2 and soon dismissed because of safety issues. The structural features of Zn-CQ complexes and the effect of CQ on zinc distribution in cells are poorly known. In this study, state-of-the-art computations combined with experiments were leveraged to solve the structural determinants of zinc-CQ interactions in solution and the solid state. NMR, ESI-MS, and X-ray absorption and diffraction methods were combined with ab initio molecular dynamics calculations to address the kinetic lability of this complex. Within the physiological pH range, CQ binds Zn²⁺ through the quinoline ring nitrogen, forming [Zn(CQH)Cl_x(H₂O)_3-x]^(3+)-x (x = 0, 1, 2, and 3) tetrahedral complexes. The Zn(CQH)Cl₃ species is stable at neutral pH and at high chloride concentrations typical of the extracellular medium, but metal coordination is lost at a moderately low pH as in the lysosomal lumen. The pentacoordinate complex [Zn(CQH)(H₂O)₄]³⁺ may exist in the absence of chloride. This in vitro/in silico approach can be extended to other metal-targeting drugs and bioinorganic systems.

Protonation and orientation: a computational approach to cocaine diffusion through a model membrane

We study the diffusion of cocaine through a DMPC lipid bilayer as an example of a protonable, amphiphilic molecule passing a biological membrane. Using classical molecular dynamics simulations, the free...