From basic concepts to emerging technologies in regional anesthesia

Dillane, Derek; Tsui, Ban C. H.

doi:10.1097/aco.0b013e32833d9513

Cited by 9 publications

(2 citation statements)

References 31 publications

(27 reference statements)

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“…Regional anaesthesia with local anaesthetic agents has the great advantage over general anaesthesia of targeting treatment to the affected site, whether by local tissue/perineural injection or epidural/intrathecal delivery, thus avoiding or minimizing systemic side effects. Although very successful for many surgical interventions (Hogan et al ., 2009; Fredrickson et al ., 2010; Hawkins, 2010; Murray et al ., 2010; Scott, 2010) as well treatment of some chronic pain conditions (Dillane and Tsui, 2010; Power et al ., 2010), the non‐selective action of currently available sodium channel blockers means that a block of motor, sensory and autonomic function inevitably occurs, even if only analgesia is required. Our strategy of using large‐pore channels to deliver sodium channel blockers into nociceptors (Binshtok et al ., 2007) provides an alternative approach.…”

Section: Discussionmentioning

confidence: 99%

Targeting of sodium channel blockers into nociceptors to produce long-duration analgesia: a systematic study and review

Roberson

Binshtok

Blasl

et al. 2011

British Journal of Pharmacology

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BACKGROUND AND PURPOSEWe have developed a strategy to target the permanently charged lidocaine derivative lidocaine N-ethyl bromide (QX-314) selectively into nociceptive sensory neurons through the large-pore transient receptor potential cation channel subfamily V (TRPV1) noxious heat detector channel. This involves co-administration of QX-314 and a TRPV1 agonist to produce a long-lasting local analgesia. For potential clinical use we propose using lidocaine as the TRPV1 agonist, because it activates TRPV1 at clinical doses. EXPERIMENTAL APPROACHWe conducted experiments in rats to determine optimal concentrations and ratios of lidocaine and QX-314 that produce the greatest degree and duration of pain-selective block when administered nearby the sciatic nerve: reduction in the response to noxious mechanical (pinch) and to radiant heat stimuli, with minimal disruption in motor function (grip strength). KEY RESULTSA combination of 0.5% QX-314 and 2% lidocaine produced 1 h of non-selective sensory and motor block followed by >9 h of pain-selective block, where grip strength was unimpaired. QX-314 at this concentration had no effect by itself, while 2% lidocaine by itself produced 1 h of non-selective block. The combination of 0.5% QX-314 and 2% lidocaine was the best of the many tested, in terms of the duration and selectivity of local analgesia. CONCLUSIONS AND IMPLICATIONSTargeting charged sodium channel blockers into specific sets of axons via activation of differentially expressed large-pore channels provides an opportunity to produce prolonged local analgesia, and represents an example of how exploiting ion channels as a drug delivery port can be used to increase the specificity and efficacy of therapeutics.

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Section: Discussionmentioning

confidence: 99%

Targeting of sodium channel blockers into nociceptors to produce long-duration analgesia: a systematic study and review

Roberson

Binshtok

Blasl

et al. 2011

British Journal of Pharmacology

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“…11,12 Recently, there have been a variety of advancements to enhance needle visibility such as improvements in transducer technology and echogenic needle design. 13 A significant advancement has been the US needle guidance positioning system (GPS) (SonixGPS; Ultrasonix Medical Corporation, Richmond, British Columbia, Canada), which consists of an electromagnetic needletracking system for US-guided needle interventions. Both current and predicted needle tip positions are displayed on the US screen in real time, facilitating needle-beam alignment and guidance to target.…”

mentioning

confidence: 99%