Antimicrobial effects of fentanyl and bupivacaine: an <i>in vitro</i> study

Kesici, Sevgi; Demirci, Mehmet; Kesici, Ugur

doi:10.1016/j.bjane.2020.04.026

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Anestesiologia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

CLINICAL RESEARCH • Rev. Bras. Anestesiol. 70 (4) • Jul-Aug 2020 • https://doi.org/10.1016/j.bjane.2020.04.026 copy

Antimicrobial effects of fentanyl and bupivacaine: an in vitro study

Authorship SCIMAGO INSTITUTIONS RANKINGS

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 Group F (Fentanyl Citrate) and 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 today's 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 against E. 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

	Group C (Control)	Group F (Fentanyl citrate)	Group B (Bupivacaine)
S. aureus ATCC 29213
12^th hour	0.00	14.10	4.00
24^th hour	0.00	15.00	4.70
P. aeruginosa ATCC 27853
12^th hour	0.00	4.40	0.00
24^th hour	0.00	5.50	0.00
E. coli ATCC 25922
12^th hour	0.00	3.60	4.80
24^th hour	0.00	4.40	5.80
K. pneumoniae ATCC 13883
12^th hour	0.00	0.00	5.70
24^th hour	0.00	0.00	6.50
C. albicans ATCC 10231
12^th hour	0.00	4.00	0.00
24^th hour	0.00	4.50	0.00

	Group C (Control)	Group F (Fentanyl citrate)	Group B (Bupivacaine)
	Mean ± SD Med. (min - max)	Mean ± SD Med. (min - max)	Mean ± SD Med. (min-max)	p ^a a Mann-Whitney U test.
S. aureus 12^th hour	0 (constant)	14.1 ± 0.7 14 (13-15)	4 ± 0.7 4 (3-5)	< 0.001
S. aureus 24^th hour	0 (constant)	15 ± 0.8 15 (14-16)	4.7 ± 0.7 5 (4-6)	< 0.001
p ^b b Wilcoxon Signed Rank test.	1.000	0.021	0.059
P. aeruginosa 12^th hour	0 (constant)	4.4 ± 0.7 4 (4-6)	0 (constant)	< 0.001
P. aeruginosa 24t^h hour	0 (constant)	5.5 ± 0.7 6 (4-6)	0 (constant)	< 0.001
p ^b b Wilcoxon Signed Rank test.	1.000	0.015	1.000
E. coli 12^th hour	0 (constant)	3.6 ± 0.7 3.5 (3-5)	4.8 ± 0.8 5 (4-6)	0.005
E. coli 24^th hour	0 (constant)	4.4 ± 0.5 4 (4-5)	5.8 ± 0.6 6 (5-7)	< 0.001
p ^b b Wilcoxon Signed Rank test.	1.000	0.033	0.008
K. pneumoniae 12^th hour	0 (constant)	0 (constant)	5.7 ± 0.9 6 (4-7)	< 0.001
K. pneumoniae 24^th hour	0 (constant)	0 (constant)	6.5 ± 0.7 7 (5-7)	< 0.001
p ^b b Wilcoxon Signed Rank test.	1.000	1.000	0.005
C. albicans 12^th hour	0 (constant)	4 ± 0.8 4 (3-5)	0 (constant)	< 0.001
C. albicans 24^th hour	0 (constant)	4.5 ± 0.5 4.5 (4-5)	0 (constant)	< 0.001
p ^b b Wilcoxon Signed Rank test.	1.000	0.096	1.000

	∑FIC Index (fentanyl citrate + bupivacaine)
S. aureus ATCC 29213
12^th hour	0.61
24^th hour	0.64
P. aeruginosa ATCC 27853
12^th hour	0.65
24^th hour	0.61
E. coli ATCC 25922
12^th hour	0.38
24^th hour	0.36
K. pneumoniae ATCC 13883
12^th hour	0.75
24^th hour	0.65
C. albicans ATCC 10231
12^th hour	0.51
24^th hour	0.51

Fentanyl citrate (mg. mL^-1)	0.078	0.156	0.313	0.625	1.25	2.50	5.00	10.00	20.00
S. aureus ATCC 29213	+	+	+	+	+	+	-a	-	-
P. aeruginosa ATCC 27853	+	+	+	+	+	+	+	+	-^a a MIC values.
E. coli ATCC 25922	+	+	+	+	+	+	+	+	+
K. pneumoniae ATCC 13883	+	+	+	+	+	+	+	+	+
C. albicans ATCC 10231	+	+	+	+	-^a a MIC values.	-	-	-	-
Bupivacaine (mg. mL^-1)	0.078	0.156	0.313	0.625	1.25	2.50	5.00	10.00	20.00
S. aureus ATCC 29213	+	+	+	+	+	+	+	+	+
P. aeruginosa ATCC 27853	+	+	+	+	+	+	+	+	+
E. coli ATCC 25922	+	+	+	+	+	+	+	+	-^a a MIC values.
K. pneumoniae ATCC 13883	+	+	+	+	+	+	+	+	-^a a MIC values.
C. albicans ATCC 10231	+	+	+	+	+	+	+	+	+
Fentanyl citrate (mg. mL^-1) + bupivacaine (mg. mL^-1)	0.078	0.156	0.313	0.625	1.25	2.50	5.00	10.00	20.00
S. aureus ATCC 29213	+	+	+	+	+	+	+	-^a a MIC values.	-
P. aeruginosa ATCC 27853	+	+	+	+	+	+	+	+	-^a a MIC values.
E. coli ATCC 25922	+	+	+	+	+	+	-^a a MIC values.	-	-
K. pneumoniae ATCC 13883	+	+	+	+	+	+	+	+	-^a a MIC values.
C. albicans ATCC 10231	+	+	+	+	+	-^a a MIC values.	-	-	-

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Corresponding author. E-mail md.kesici@mynet.com (S. Kesici).