1
|
Zhao M, Zhou M, Lu P, Wang Y, Zeng R, Liu L, Zhu S, Kong L, Zhang J. Local anesthetic delivery systems for the management of postoperative pain. Acta Biomater 2024; 181:1-18. [PMID: 38679404 DOI: 10.1016/j.actbio.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/29/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Abstract
Postoperative pain (POP) is a major clinical challenge. Local anesthetics (LAs), including amide-type LAs, ester-type LAs, and other potential ion-channel blockers, are emerging as drugs for POP management because of their effectiveness and affordability. However, LAs typically exhibit short durations of action and prolonging the duration by increasing their dosage or concentration may increase the risk of motor block or systemic local anesthetic toxicity. In addition, techniques using LAs, such as intrathecal infusion, require professional operation and are prone to catheter displacement, dislodgement, infection, and nerve damage. With the development of materials science and nanotechnology, various LAs delivery systems have been developed to compensate for these disadvantages. Numerous delivery systems have been designed to continuously release a safe dose in a single administration to ensure minimal systemic toxicity and prolong pain relief. LAs delivery systems can also be designed to control the duration and intensity of analgesia according to changes in the external trigger conditions, achieve on-demand analgesia, and significantly improve pain relief and patient satisfaction. In this review, we summarize POP pathways, animal models and methods for POP testing, and highlight LAs delivery systems for POP management. STATEMENT OF SIGNIFICANCE: Postoperative pain (POP) is a major clinical challenge. Local anesthetics (LAs) are emerging as drugs for POP management because of their effectiveness and affordability. However, they exhibit short durations and toxicity. Various LAs delivery systems have been developed to compensate for these disadvantages. They have been designed to continuously release a safe dose in a single administration to ensure minimal toxicity and prolong pain relief. LAs delivery systems can also be designed to control the duration and intensity of analgesia to achieve on-demand analgesia, and significantly improve pain relief and patient satisfaction. In this paper, we summarize POP pathways, animal models, and methods for POP testing and highlight LAs delivery systems for POP management.
Collapse
Affiliation(s)
- Mingxu Zhao
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China; Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230031, China
| | - Mengni Zhou
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China
| | - Pengcheng Lu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China
| | - Ying Wang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China
| | - Rong Zeng
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230031, China
| | - Lifang Liu
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230031, China
| | - Shasha Zhu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China.
| | - Lingsuo Kong
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230031, China.
| | - Jiqian Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Key Laboratory of Anesthesia and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, 230032, China.
| |
Collapse
|
2
|
Yu YH, Lee CH, Hsu YH, Chou YC, Hong BK, Huang CT, Liu SJ. Novel CO 2-encapsulated Pluronic F127 hydrogel for the treatment of Achilles tendon injury. Sci Rep 2023; 13:21895. [PMID: 38081952 PMCID: PMC10713641 DOI: 10.1038/s41598-023-49339-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/07/2023] [Indexed: 12/18/2023] Open
Abstract
Nonsurgical treatment and surgical repairment of injured Achilles tendons seldom restore the wounded tendon to its original elasticity and stiffness. Therefore, we hypothesized that the surgically repaired Achilles tendon can achieve satisfactory regeneration by applying multi-drug encapsulated hydrogels. In this study, a novel bupivacaine-eluting carbon dioxide-encapsulated Pluronic F127 hydrogel (BC-hydrogel) was developed for the treatment of Achilles tendon injuries. The rheological properties of BC-hydrogel were measured. A high-performance liquid chromatography assay was used to assess the release characteristics of bupivacaine in both in vitro and in vivo settings. Furthermore, the effectiveness of BC-hydrogel in treating torn tendons was examined in a rat model, and histological analyses were conducted. Evidently, the degradable hydrogels continuously eluted bupivacaine for more than 14 days. The animal study results revealed that the BC-hydrogel improved the post-surgery mobility of the animals compared with pristine hydrogels. Histological assay results demonstrated a significant reaction to high vascular endothelial growth factor in the surrounding tissues and expression of collagen I within the repaired tendon. This demonstrates the potential of this novel BC-hydrogel as an effective treatment method for Achilles tendon injuries.
Collapse
Affiliation(s)
- Yi-Hsun Yu
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, 33305, Taiwan
| | - Chen-Hung Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou, Chang Gung University College of Medicine, Tao-Yuan, 33305, Taiwan
| | - Yung-Heng Hsu
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, 33305, Taiwan
| | - Ying-Chao Chou
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, 33305, Taiwan
| | - Bo-Kui Hong
- Department of Mechanical Engineering, Chang Gung University, Tao-Yuan, 33302, Taiwan
| | - Chao-Tsai Huang
- Department of Chemical and Materials Engineering, Tamkang University, New Taipei City, 251301, Taiwan
| | - Shih-Jung Liu
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, 33305, Taiwan.
- Department of Mechanical Engineering, Chang Gung University, Tao-Yuan, 33302, Taiwan.
- Biomaterials Lab, Mechanical Engineering, Chang Gung University, 259, Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, 33302, Taiwan.
| |
Collapse
|
3
|
Nagella SR, Choi S, Park SY, Ha CS, Jung Y, Chitumalla RK, Jang J, Yoon JY, Chung I. Depolymerized Chitosan-g-[Poly(MMA-co-HEMA-cl-EGDMA)] Based Nanogels for Controlled Local Release of Bupivacaine. Int J Mol Sci 2023; 24:16470. [PMID: 38003661 PMCID: PMC10671397 DOI: 10.3390/ijms242216470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
This study is designed to formulate and characterize chitosan-based nanogels that provide the controlled delivery of anesthetic drugs, such as bupivacaine (BPV), for effective postoperative pain management over prolonged periods of time. Drug carriers of chitosan/poly (MMA-co-HEMA-cl-EGDMA) (CsPMH) nanogels were prepared by varying the composition of comonomers such as MMA, HEMA, and redox initiator CAN. The nanogels were then characterized using FTIR, TGA, SEM, and TEM. The CsPMH nanogels showed greater encapsulation efficiencies from 43.20-91.77%. Computational studies were also conducted to evaluate the interaction between the drug and CsPMH nanoparticles. Finally, BPV-loaded nanoparticles were used to examine their in vitro release behavior. At pH 7.4, all the drug carriers displayed the "n" value around 0.7, thus the BPV release follows anomalous diffusion. Drug carrier 7 demonstrated a steady and sustained release of BPV for approximately 24 h and released about 91% of BPV, following the K-P mechanism of drug release. On the other hand, drug carrier 6 exhibited controlled release for approximately 12 h and released only 62% of BPV.
Collapse
Affiliation(s)
- Sivagangi Reddy Nagella
- Department of Polymer Science and Engineering, Pusan National University, Busan 46241, Republic of Korea; (S.R.N.); (C.-S.H.)
| | - Soojeong Choi
- Department of Polymer Science and Engineering, Pusan National University, Busan 46241, Republic of Korea; (S.R.N.); (C.-S.H.)
| | - Soo-Yong Park
- Department of Polymer Science and Engineering, Pusan National University, Busan 46241, Republic of Korea; (S.R.N.); (C.-S.H.)
| | - Chang-Sik Ha
- Department of Polymer Science and Engineering, Pusan National University, Busan 46241, Republic of Korea; (S.R.N.); (C.-S.H.)
| | - Youngmi Jung
- Department of Biological Sciences, College of Natural Science, Pusan National University, Busan 46241, Republic of Korea;
| | - Ramesh Kumar Chitumalla
- Department of Nanoenergy Engineering, Pusan National University, Busan 46241, Republic of Korea;
| | - Joonkyung Jang
- Department of Nanoenergy Engineering, Pusan National University, Busan 46241, Republic of Korea;
| | - Ji-Young Yoon
- Department of Dental Anesthesia and Pain Medicine, School of Dentistry, Pusan National University, Gyeongsangnam-do, Yangsan 50612, Republic of Korea
- Dental Research Institute, Pusan National University Dental Hospital, Gyeongsangnam-do, Yangsan 50612, Republic of Korea
| | - Ildoo Chung
- Department of Polymer Science and Engineering, Pusan National University, Busan 46241, Republic of Korea; (S.R.N.); (C.-S.H.)
- Dental Research Institute, Pusan National University Dental Hospital, Gyeongsangnam-do, Yangsan 50612, Republic of Korea
| |
Collapse
|
4
|
Steverink JG, van Tol FR, Bruins S, Smorenburg AJ, Tryfonidou MA, Oosterman BJ, van Dijk MR, Malda J, Verlaan JJ. Lack of concentration-dependent local toxicity of highly concentrated (5%) versus conventional 0.5% bupivacaine following musculoskeletal surgery in a rat model. J Exp Orthop 2023; 10:21. [PMID: 36884187 PMCID: PMC9995632 DOI: 10.1186/s40634-023-00591-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/01/2023] [Indexed: 03/09/2023] Open
Abstract
PURPOSE Various sustained-release formulations incorporate high bupivacaine concentrations but data on local toxicity is lacking. This study explores local toxic effects of highly concentrated (5%) bupivacaine compared to clinically used concentrations in vivo following skeletal surgery, to assess the safety of sustained-release formulations with high bupivacaine concentrations. METHODS Sixteen rats underwent surgery, in which screws with catheters affixed were implanted in the spine or femur in a factorial experimental design, allowing single-shot or continuous 72 h local administration of 0.5%, 2.5% or 5.0% bupivacaine hydrochloride. During the 30-day follow-up, animal weight was recorded and blood samples were obtained. Implantation sites underwent histopathological scoring for muscle damage, inflammation, necrosis, periosteal reaction/thickening and osteoblast activity. Effects of bupivacaine concentration, administration mode and implantation site on local toxicity scores were analyzed. RESULTS Chi-squared tests for score frequencies revealed a concentration-dependent decrease in osteoblast count. Moreover, spinal screw implantation led to significantly more muscle fibrosis but less bone damage than femoral screw implantation, reflecting the more invasive muscle dissection and shorter drilling times related to the spinal procedure. No differences between bupivacaine administration modes regarding histological scoring or body weight changes were observed. Weight increased, while CK levels and leukocyte counts decreased significantly during follow-up, reflecting postoperative recovery. No significant differences in weight, leukocyte count and CK were found between interventional groups. CONCLUSION This pilot study found limited concentration-dependent local tissue effects of bupivacaine solutions concentrated up to 5.0% following musculoskeletal surgery in the rat study population.
Collapse
Affiliation(s)
- Jasper G Steverink
- Department of Orthopedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, Netherlands. .,SentryX B.V, Austerlitz, Netherlands.
| | - Floris R van Tol
- Department of Orthopedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, Netherlands.,SentryX B.V, Austerlitz, Netherlands
| | | | | | - Marianna A Tryfonidou
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | | | - Marijke R van Dijk
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jos Malda
- Department of Orthopedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, Netherlands.,Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Jorrit-Jan Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, Netherlands.,SentryX B.V, Austerlitz, Netherlands
| |
Collapse
|
5
|
Zeng C, Wu P, Guo J, Zhao N, Ke C, Liu G, Zhou F, Liu W. Synergy of Hofmeister effect and ligand crosslinking enabled the facile fabrication of super-strong, pre-stretching-enhanced gelatin-based hydrogels. SOFT MATTER 2022; 18:8675-8686. [PMID: 36349798 DOI: 10.1039/d2sm01158a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Hydrogels are becoming increasingly popular in biomedical and soft machine manufacturing, but their practical application is limited by poor mechanical properties. In recent years, Hofmeister effect-enhanced gelatin hydrogels have become popular. However, the synergy of the Hofmeister effect using other toughening methods is still less investigated. We have fabricated an ultra-high strength gelatin-based hydrogel by introducing ligand cross-linking and hydrogen bonds. Unlike conventional double-network hydrogels, the dense physical cross-linking involving sacrificial bonds gives the hydrogel excellent fatigue resistance and self-recovery properties. The enhancement of mechanical properties by the Hofmeister effect is attributed to the disruption of the hydration shell of the gelatin molecular chains, which leads to stronger interactions between the molecular chains. The mechanical properties of the hydrogels are adjustable over a wide range by varying the concentration of the soaked (NH4)2SO4 solution. The fixation of the gelatin molecular chain orientation by the Hofmeister effect and the reorganization of the coordination bonds allow the hydrogels to be self-reinforced by pre-stretching. At the same time, the modulus contraction of hydrogels in high-concentration salt solutions, and relaxation and swelling in dilute solutions exhibit ionic stimulation responses and shape recovery capability, and hybrid hydrogels have great potential as bio-actuators.
Collapse
Affiliation(s)
- Cheng Zeng
- Center of Advanced Lubrication and Sealing Materials, State Key Laboratory of Solidification Processing, Northwestern Polytechnical University, Xi'an 710072, China.
| | - Pengxi Wu
- Center of Advanced Lubrication and Sealing Materials, State Key Laboratory of Solidification Processing, Northwestern Polytechnical University, Xi'an 710072, China.
| | - Jinglun Guo
- Center of Advanced Lubrication and Sealing Materials, State Key Laboratory of Solidification Processing, Northwestern Polytechnical University, Xi'an 710072, China.
| | - Nan Zhao
- Center of Advanced Lubrication and Sealing Materials, State Key Laboratory of Solidification Processing, Northwestern Polytechnical University, Xi'an 710072, China.
| | - Cheng Ke
- Center of Advanced Lubrication and Sealing Materials, State Key Laboratory of Solidification Processing, Northwestern Polytechnical University, Xi'an 710072, China.
| | - Guoqiang Liu
- Center of Advanced Lubrication and Sealing Materials, State Key Laboratory of Solidification Processing, Northwestern Polytechnical University, Xi'an 710072, China.
| | - Feng Zhou
- State Key Laboratory of Solid Lubrication, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou 730000, China
| | - Weimin Liu
- Center of Advanced Lubrication and Sealing Materials, State Key Laboratory of Solidification Processing, Northwestern Polytechnical University, Xi'an 710072, China.
- State Key Laboratory of Solid Lubrication, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou 730000, China
| |
Collapse
|