Tetrodotoxin-bupivacaine-epinephrine combinations for prolonged local anesthesia

Charles B. Berde, Umeshkumar Athiraman, Barak Yahalom, David Zurakowski, Gabriel Corfas, Christina Bognet

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Currently available local anesthetics have analgesic durations in humans generally less than 12 hours. Prolonged-duration local anesthetics will be useful for postoperative analgesia. Previous studies showed that in rats, combinations of tetrodotoxin (TTX) with bupivacaine had supra-additive effects on sciatic block durations. In those studies, epinephrine combined with TTX prolonged blocks more than 10-fold, while reducing systemic toxicity. TTX, formulated as Tectin, is in phase III clinical trials as an injectable systemic analgesic for chronic cancer pain. Here, we examine dose-duration relationships and sciatic nerve histology following local nerve blocks with combinations of Tectin with bupivacaine 0.25% (2.5 mg/mL) solutions, with or without epinephrine 5 μg/mL (1:200,000) in rats. Percutaneous sciatic blockade was performed in Sprague-Dawley rats, and intensity and duration of sensory blockade was tested blindly with different Tectin-bupivacaine-epinephrine combinations. Between-group comparisons were analyzed using ANOVA and post-hoc Sidak tests. Nerves were examined blindly for signs of injury. Blocks containing bupivacaine 0.25% with Tectin 10 μM and epinephrine 5 μg/mL were prolonged by roughly 3-fold compared to blocks with bupivacaine 0.25% plain (P < 0.001) or bupivacaine 0.25% with epinephrine 5 μg/mL (P < 0.001). Nerve histology was benign for all groups. Combinations of Tectin in bupivacaine 0.25% with epinephrine 5 μg/mL appear promising for prolonged duration of local anesthesia.

Original languageEnglish
Pages (from-to)2717-2728
Number of pages12
JournalMarine Drugs
Issue number12
StatePublished - Dec 2011


  • Bupivacaine
  • Epinephrine
  • Local anesthesia
  • Sciatic blockade
  • Tetrodotoxin


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