title: Stereoselectivity of bupivacaine in local anesthetic-sensitive ion channels of peripheral nerve.
abstract: BACKGROUND
  The local anesthetic bupivacaine exists in two stereoisomeric forms, R(+)- and S(-)-bupivacaine. Because of its lower cardiac and central nervous system toxicity, attempts were made recently to introduce S(-)-bupivacaine into clinical anesthesia. We investigated stereoselective actions of R(+)-and S(-)-bupivacaine toward two local anesthetic-sensitive ion channels in peripheral nerve, the Na+ and the flicker K+ channel.
  
  
  METHODS
  In patch-clamp experiments on enzymatically demyelinated peripheral amphibian nerve fibers, Na+ and flicker K+ channels were investigated in outside-out patches. Half-maximum inhibiting concentrations (IC50) were determined. For the flicker K+ channel, simultaneous block by R(+)-bupivacaine and S(-)-bupivacaine was analyzed for competition and association (k1) and dissociation rate constants (k(-1)) were determined.
  
  
  RESULTS
  Both channels were reversibly blocked by R(+)- and S(-)-bupivacaine. The IC50 values (+/- SEM) for tonic Na+ channel block were 29+/-3 microM and 44+/-3 microM, respectively. IC50 values for flicker K+ channel block were 0.15+/-0.02 microM and 11+/-1 microM, respectively, resulting in a high stereopotency ratio (+/-) of 73. Simultaneously applied enantiomers competed for a single binding site. Rate constants k1 and k(-1) were 0.83+/-0.13x10(6) M(-1) x S(-1) and 0.13+/-0.03 s(-1), respectively, for R(+)-bupivacaine and 1.90+/-0.20x10(6) M(-1) x s(-1) and 8.3+/-1.0 s(-1), respectively, for S(-)-bupivacaine.
  
  
  CONCLUSIONS
  Bupivacaine block of Na+ channels shows no salient stereoselectivity. Block of flicker K+ channels has the highest stereoselectivity ratio of bupivacaine action known so far. This stereoselectivity derives predominantly from a difference in k(-1), suggesting a tight fit between R(+)-bupivacaine and the binding site. The flicker K+ channel may play an important role in yet unknown toxic mechanisms of R(+)-bupivacaine.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Justus-Liebig-University, Giessen, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Nau
authors.forename: W
authors.initials: W
authors.lastname: Vogel
authors.forename: G
authors.initials: G
authors.lastname: Hempelmann
authors.forename: M E
authors.initials: ME
authors.lastname: Bräu
mesh_terms: D000779:Anesthetics, Local / Q000494:pharmacology*; D000818:Animals; D002045:Bupivacaine / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D010525:Peripheral Nerves / Q000187:drug effects*; D015221:Potassium Channels / Q000187:drug effects*; D015222:Sodium Channels / Q000187:drug effects*; D013237:Stereoisomerism; D014982:Xenopus laevis
chemical_list: D000779:Anesthetics, Local; D015221:Potassium Channels; D015222:Sodium Channels; D002045:Bupivacaine