Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.04.026
Brazilian Journal of Anesthesiology
Clinical Research

Antimicrobial effects of fentanyl and bupivacaine: Antimicrobial effects of bupivacaine and fentanyl

Efeitos antimicrobianos do fentanil e da bupivacaína: estudo in vitro

Sevgi Kesıcı, Mehmet Demırcı, Ugur Kesıcı

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Abstract

Study objective
In this study, we aimed to compare the antimicrobial effects of bupivacaine and fentanyl citrate and to reveal the impact on antimicrobial effect potential in the case of combined use.

Design
In vitro prospective study.

Setting
University Clinical Microbiology Laboratory.

Measurements
In our study, in vitro antimicrobial effect of 0.05 mg.mL-1 fentanyl citrate, 5 mg.mL-1 bupivacaine were tested against Staphylococcus aureus American Type Culture Collection (ATCC) 29213, Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883, Escherichia coli ATCC 25922 and Candida albicans ATCC 10231 as a Group F (Fentanyl Citrate), Group B (Bupivacaine) respectively. S. aureus ATCC 29213, P. aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883 and Escherichia coli ATCC 25922 were cultured onto Mueller Hinton agar (Oxoid, UK) plates and Candida albicans ATCC 10231 were cultured onto Sabouraud dextrose agar (Oxoid, UK) plates for 18 − 24 hours at 37 °C.

Main results
In terms of inhibition zone diameters,S. Aureus ATCC 29213, P. aeruginosa ATCC 27853, and C. albicans ATCC10231 values obtained after 12 and 24 hours of incubation ​​were significantly higher in Group F than Group B (p <  0.001). In terms of inhibition zone diameters, E. coli ATCC 25922, and K. pneumomiae ATCC 13883 values obtained after 12 and 24 hours of incubation ​​were significantly higher in Group B than Group F (p <  0.001, E. coli 12ª hour p  = 0.005).

Conclusions
Addition of fentanyl to Local Anesthetics (LAs) is often preferred in regional anesthesia applications in todays practice owing especially to its effect on decreasing the local anesthetic dose and increasing analgesia quality and patient satisfaction. However, when the fact that fentanyl antagonized the antimicrobial effects of LAs in the studies is taken into account, it might be though that it contributes to an increase in infection complications. When the fact that fentanyl citrate which was used in our study and included hydrochloric acid and sodium hydroxide as protective agents, broadened the antimicrobial effect spectrum of LAs, had no antagonistic effect and showed a synergistic antimicrobial effect againstE. Coli is considered, we are of the opinion that the addition of fentanyl to LAs would contribute significantly in preventing the increasing regional anesthesia infection complications.

Keywords

Antimicrobial;  Bupivacaine;  Fentanyl;  Regional anesthesia;  Infections

Resumo

Objetivo
O objetivo do presente estudo foi comparar os efeitos antimicrobianos da bupivacaína e citrato de fentanil e revelar o impacto no potencial do efeito antimicrobiano no caso de uso combinado.

Desenho
Estudo prospectivo in vitro.

Local
Laboratório de Microbiologia Clínica da Universidade.

Medidas
Em nosso estudo, os efeitos antimicrobianos in vitro do citrato de fentanil na concentração de 0,05 mg.mL-1 – Grupo F e da bupivacaína na concentração de 5 mg.mL-1 – Grupo B foram testados em culturas de Staphylococcus aureus ATCC 29213 (do inglês American Type Culture Collection 29213), Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883, Escherichia coli ATCC 25922 e Candida albicans ATCC 10231. As culturas de S. aureus ATCC 29213, P. aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883 e Escherichia coli ATCC 25922 foram semeadas em placas de ágar Mueller Hinton (Oxoid, Reino Unido), e a cultura de Candida albicans ATCC 10231 foi realizada em placa de ágar Sabouraud dextrose (Oxoid, Reino Unido) durante 18 − 24 horas a 37 °C.

Principais resultados
Com relação ao diâmetro da zona de inibição, os valores de S. aureus ATCC 29213, P. aeruginosa ATCC 27853 e C. albicans ATCC10231 obtidos após 12 e 24 horas de incubação foram significantemente maiores no Grupo F do que no Grupo B (p <  0,001). Os valores do diâmetro da zona de inibição das culturas de E. coli ATCC 25922 e K. pneumomiae ATCC 13883 obtidos após 12 e 24 horas de incubação foram significantemente maiores no Grupo B do que no Grupo F (p < 0,001, E. coli na 12ª hora p =  0,005)

Conclusões
A preferência atual e frequente pela adição de fentanil aos Anestésicos Locais (AL) para a realização de anestesia regional se deve sobretudo à possibilidade de redução da dose do anestésico local, a melhora na qualidade da analgesia e a satisfação do paciente. No entanto, ao considerar estudos em que o fentanil antagonizou o efeito antimicrobiano dos AL, pode-se pensar que esse fato contribua para aumento de complicação infecciosa. O citrato de fentanil usado em nosso estudo, contendo ácido clorídrico e hidróxido de sódio como agentes conservantes, ampliou o espectro de efeitos antimicrobianos dos AL, não teve efeito antagônico e mostrou efeito antimicrobiano sinérgico contra a E. coli. Acreditamos que a adição de fentanil aos anestésicos locais traria importante contribuição na prevenção das crescentes complicações por infecção da anestesia regional.

Palavras-chave

Antimicrobiano;  Bupivacaína;  Fentanil;  Anestesia regional;  Infecções

References

1 U. Kesici, M. Demirci, S. Kesici Antimicrobial effects of local anaesthetics Int Wound J., 16 (2019), pp. 1029-1033

2 A. Khanna, R. Saxena, A. Dutta, et al. Comparison of ropivacaine with and without fentanyl vs bupivacaine with fentanyl for postoperative epidural analgesia in bilateral total knee replacement surgery J Clin Anesth., 37 (2017), pp. 7-13

3 L. Van Leeuwen, L. Deen, J.H.A. Helmers Comparison of alfentanil and fentanyl in short operations with special reference to their duration of action and postoperative respiratory depression Anaesthesist., 30 (1981), pp. 397-399

4 B. Li, H. Wang, C. Gao Bupivacaine in combination with fentanyl or sufentanil in epidural/intrathecal analgesia for labor: a meta-analysis J Clin Pharmacol., 55 (2015), pp. 584-591

5 E. Mutlu In vitro ınvestigation of the antibacterial effects of lidocaine and bupivacaine alone andin combinations with fentanyl Turkiye Klinikleri J Med Sci., 38 (2018), pp. 334-339

6 B.M. Razavi, B.S. Fazly Bazzaz A review and new insights to antimicrobial action of local anesthetics Eur J Clin Microbiol Infect Dis, 38 (2019), pp. 991-1002

7 CLSI (Clinical and Laboratory Standards Institute): Dilution anti-microbial susceptibility tests for bacteria that grow aerobically. Approved standart (10 ed.), CLSI document (2015), pp. M7-A10

8 L.B. Oyama, J.A. Crochet, J.E. Edwards, et al. Buwchitin: a ruminal peptide with antimicrobial potential against enterococcus faecalis Front Chem., 5 (2017), p. 51

9 M.G. Botelho Fractional inhibitory concentration index of combinations of antibacterial agents against cariogenic organisms J Dent, 28 (2000), pp. 565-570

10 O.N. Aydin, M. Eyigor, O.N. Aydin Antimicrobial activity of ropivacaine and other local anaesthetics Eur J Anaesthesiol., 18 (2001), pp. 687-694

11 Y. Sun, Y. Xu, G.N. Wang Comparative Evaluation of Intrathecal Bupivacaine Alone, Bupivacaine-fentanyl, and Bupivacaine-dexmedetomidine in Caesarean Section Drug Res (Stuttg), 65 (2015), pp. 468-472

12 M.W. Coghlan, M.J. Davies, C. Hoyt, et al. Antibacterial activity of epidural infusions Anaesth Intensive Care., 37 (2009), pp. 66-69

13 S. Kesici, M. Demirci, U. Kesici Bacterial inhibition efficiency of prilocaine and bupivacaine Int Wound J., 16 (2019), pp. 1185-1189

14 E. Reihsaus, H. Waldbaur, W. Seeling Spinal epidural abscess: a meta-analysis of 915 patients Neurosurg Rev, 23 (2000), pp. 175-204

15 S. Grewal, G. Hocking, J.A. Wildsmith Epidural abscess Br J Anaesth., 96 (2006), pp. 292-302

16 L.P. Wang, J. Hauerberg, J.F. Schmidt Incidence of spinal epidural abscess after epidural analgesia: a national 1-year survey Anesthesiology., 91 (1999), pp. 1928-1936

17 J.M. Feldman, K. Chapin-Robertson, J. Turner Do agents used for epidural analgesia have antimicrobial properties? Reg Anesth., 19 (1994), pp. 43-47

18 P.H. Rosenberg, O.V. Renkonen Antimicrobial activity of bupivacaine and morphine Anesthesiology., 62 (1985), pp. 178-179

19 Z. Tamanai-Shacoori, V. Shacorri, Vo Van JM, et al. Sufentanil modifies the antibacterial activity of bupivacaine and ropivacaine Can J Anaesth., 51 (2004), pp. 911-914

20 S. Kampe, C. Poetter, S. Buzello, et al. Ropivacaine 0.1% with sufentanil 1 microg/L inhibits in vitro growth of Pseudomonas aeruginosa and does not promote multiplication of Staphylococcus aureus Anesth Analg., 97 (2003), pp. 409-411

21 T.Z. Apan, A. Apan, S. Şahin, et al. Antibacterial activity of remifentanil and mixtures of remifentanil and propofol J Clin Anesth., 19 (2007), pp. 346-350

22 M. Charaibi, K.F. Benbrahim, H. Elmsellem, et al. Antibacterial activity and corrosion inhibition of mild steel in 1.0 M hydrochloric acid solution by M. piperita and M. pulegium essential oils JMES., 8 (2017), pp. 972-981

23 P. Chavant, B. Gaillard-Martinie, M. Hébraud Antimicrobial effects of sanitizers against planktonic and sessile Listeria monocytogenes cells according to the growth phase FEMS Microbiol Lett., 236 (2004), pp. 241-248
 

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