The effects of ropivacaine on sodium currents in dorsal horn neurons of neonatal rats

Anesthetics: from modes of action to unconsciousness and neurotoxicity

Modern anesthetic compounds and advanced monitoring tools have revolutionized the field of medicine, allowing for complex surgical procedures to occur safely and effectively. Faster induction times and quicker recovery periods of current anesthetic agents have also helped reduce health care costs significantly. Moreover, extensive research has allowed for a better understanding of anesthetic modes of action, thus facilitating the development of more effective and safer compounds. Notwithstanding the realization that anesthetics are a prerequisite to all surgical procedures, evidence is emerging to support the notion that exposure of the developing brain to certain anesthetics may impact future brain development and function. Whereas the data in support of this postulate from human studies is equivocal, the vast majority of animal research strongly suggests that anesthetics are indeed cytotoxic at multiple brain structure and function levels. In this review, we first highlight various modes of anesthetic action and then debate the evidence of harm from both basic science and clinical studies perspectives. We present evidence from animal and human studies vis-à-vis the possible detrimental effects of anesthetic agents on both the young developing and the elderly aging brain while discussing potential ways to mitigate these effects. We hope that this review will, on the one hand, invoke debate vis-à-vis the evidence of anesthetic harm in young children and the elderly, and on the other hand, incentivize the search for better and less toxic anesthetic compounds.

Searching for New Leads To Treat Epilepsy: Target-Based Virtual Screening for the Discovery of Anticonvulsant Agents

The purpose of this investigation is to contribute to the development of new anticonvulsant drugs to treat patients with refractory epilepsy. We applied a virtual screening protocol that involved the search into molecular databases of new compounds and known drugs to find small molecules that interact with the open conformation of the Nav1.2 pore. As the 3D structure of human Nav1.2 is not available, we first assembled 3D models of the target, in closed and open conformations. After the virtual screening, the resulting candidates were submitted to a second virtual filter, to find compounds with better chances of being effective for the treatment of P-glycoprotein (P-gp) mediated resistant epilepsy. Again, we built a model of the 3D structure of human P-gp, and we validated the docking methodology selected to propose the best candidates, which were experimentally tested on Nav1.2 channels by patch clamp techniques and in vivo by the maximal electroshock seizure (MES) test. Patch clamp studies allowed us to corroborate that our candidates, drugs used for the treatment of other pathologies like Ciprofloxacin, Losartan, and Valsartan, exhibit inhibitory effects on Nav1.2 channel activity. Additionally, a compound synthesized in our lab, N, N'-diphenethylsulfamide, interacts with the target and also triggers significant Na1.2 channel inhibitory action. Finally, in vivo studies confirmed the anticonvulsant action of Valsartan, Ciprofloxacin, and N, N'-diphenethylsulfamide.

Effectiveness of the association between carbamazepine and peripheral analgesic block with ropivacaine for the treatment of trigeminal neuralgia

Treatment of trigeminal neuralgia (TN) is achieved by using adjuvant analgesics like antiepileptics, with carbamazepine (CBZ) being the first-line approach for TN patients, although side effects may be present. Other approaches using gabapentin, namely when associated with peripheral analgesic block of TN trigger points with the local anesthetic ropivacaine (ROP), resulted in decreased pain and daily drug intake (reduced side effects). This study evaluates if the association between CBZ and the peripheral block with ROP reinforces the clinical value of CBZ. In this parallel, double-blinded study, idiopathic TN patients were randomized to receive during 4 weeks either CBZ (CBZ; n = 21) or CBZ associated with the peripheral analgesic block using ROP (CBZ + ROP; n = 24). The primary outcome measures were the following: i) pain intensity, evaluated by the numerical rating scale; ii) number of pain crises; and iii) number needed to treat. Evaluation points were at the beginning (day 1) and end (day 29) of treatment and after a follow-up of 5 months (month 6). Both protocols resulted in a decrease of pain intensity and number of pain crises, but only the association CBZ + ROP showed i) a significant stronger reduction in pain intensity at month 6 and ii) a significant decrease in the daily dose of CBZ given to patients (both at day 29 and month 6). In contrast, the daily dose in CBZ-only patients remained constant or even increased. The number needed to treat for the association CBZ + ROP over the CBZ protocol reduced from 5 at the end of the 4-week treatment to 3 after the 5-month follow-up. Data reinforce the use of CBZ as a primary tool to control pain in TN patients, as the association CBZ + ROP i) improves the clinical qualities of CBZ, ii) strongly reduces the daily dose of CBZ, and iii) reduces the potential side effects attributed to high doses of CBZ.

[Peridural application of ropivacaine and clonidine for pain therapy after prostatectomy]

OBJECTIVE

The aim of this study was to find out if ropivacaine with clonidine can be successfully used after radical retropubic prostatectomy.

MATERIAL AND METHODS

A total of 86 patients were randomized into two groups each consisting of 43 patients. Patients in group 1 received epidural bupivacaine/morphine/clonidine and those in group 2 ropivacaine and clonidine. If necessary analgesic, antiemetic or antihistamine drugs were administered. Pain on a visual analogue scale (VAS), motoric and sensoric disturbances, sedation, itching, nausea and vomiting, hypotension, need of antihistamines, naloxon, antiemetics, ephedrine, and analgesics were also documented.

RESULTS

Differences in sedation, itching, nausea and vomiting, motoric and sensoric disturbances, need of antihistamines, antiemetics, and ketoprofen were significant, the other parameters did not show any significant differences.

CONCLUSIONS

We recommend the use of ropivacaine with clonidine in the postoperative pain management after radical retropubic prostatectomy.

Differential effects of bupivacaine enantiomers, ropivacaine and lidocaine on up-regulation of cell surface voltage-dependent sodium channels in adrenal chromaffin cells

In cultured bovine adrenal chromaffin cells, (+/-)-bupivacaine inhibited veratridine-induced 22Na(+) influx (IC(50) 6.8 microM). The IC(50) of (+)-bupivacaine (2.8 microM) was 6.2-, 7.4-, and 17.1-fold lower than those of (-)-bupivacaine (17.3 microM), (-)-ropivacaine (20.6 microM), and lidocaine (47.8 microM). Chronic (i.e. 3-h) treatment of cells with (+/-)-bupivacaine increased cell surface [3H]saxitoxin ([3H]STX) binding capacity by 48% (EC(50) of 233 microM; t(1/2)=7.4 h), without changing the K(d) value. Treatment for 24 h with either (+)- or (-)-bupivacaine, or (-)-ropivacaine elevated [3H]STX binding, whereas 24-h treatment with lidocaine had no effect. The rise of [3H]STX binding by (+/-)-bupivacaine was prevented by cycloheximide, an inhibitor of protein synthesis, or brefeldin A, an inhibitor of cell surface vesicular exit from the trans-Golgi network; however, (+/-)-bupivacaine did not increase Na(+) channel alpha- and beta(1)-subunit mRNA levels. In cells subjected to (+/-)-bupivacaine treatment (1 mM for 24 h) followed by 3-h washout, veratridine-induced 22Na(+) influx was enhanced, even when measured in the presence of ouabain, an inhibitor of Na(+),K(+)-ATPase. Ptychodiscus brevis toxin-3 potentiated veratridine-induced 22Na(+) influx by 2.3-fold in the (+/-)-bupivacaine-treated cells, as in non-treated cells. These results suggest that lipophilic bupivacaine enantiomers or (-)-ropivacaine acutely inhibit Na(+) channel gating, whereas its chronic treatment up-regulates cell surface expression of Na(+) channels via translational and externalization events.

Analgesic, behavioral, and hemodynamic and respiratory effects of midsacral subarachnoidally administered ropivacaine hydrochloride in mares

OBJECTIVE

To determine the analgesic, behavioral, hemodynamic and respiratory effects of midsacral subarachnoid administration of ropivacaine hydrochloride solution in mares.

STUDY DESIGN

Randomized, blinded study.

ANIMALS

Ten healthy mares, weighing from 470 to 560 kg.

METHODS

Intravascular and subarachnoid catheters were placed after infiltration of the skin and subcutaneous tissues with 2% lidocaine. Ropivacaine (0.2%, 5 mL) or 0.9% NaCl was then administered subarachnoidally at the midsacral (S2-S3) vertebrae. Analgesia was determined by lack of sensory perception to electrical stimulation (>40 mA) and absence of response to needle pricks extending from coccygeal to S1 dermatomes. Numerical scores of sedation, change in pelvic limb position, sweating in analgesic zones, urination, behavior, response to noise, and compliance with restraint were determined. Two-way ANOVA with repeated measures and Dunnett's t-tests were used to evaluate differences between the listed numerical scores, and cardiovascular and respiratory variables before and during a 5-hour testing period.

RESULTS

Subarachnoidally administered ropivacaine-induced variable analgesia extending bilaterally from the coccyx to S1, with minimal sedation and change in pelvic limb position in standing mares. Perineal analgesia was attained at 7.5 +/- 2.6 minutes and lasted for 218 +/- 44 minutes (mean +/- SD). Subarachnoid ropivacaine significantly reduced respiratory rates and did not change heart rate, rectal temperature, arterial blood pressure, PCV, arterial gas tensions (PaO2 and PaCO2), pH, and arterial standard bicarbonate and base excess from baseline.

CONCLUSION AND CLINICAL RELEVANCE

Ropivacaine (0.2% solution, 5 mL 500 kg(-1)) can be administered subarachnoidally at midsacral (S2-S3) vertebrae to produce prolonged (>3 hours) bilateral perineal analgesia with minimal changes of behavior, and circulatory and respiratory disturbances in standing mares.