Interaction of Bupivacaine and Tetracaine with the Sarcoplasmic Reticulum Ca2+ Release Channel of Skeletal and Cardiac Muscles

Background: Although various local anesthetics can cause histologic damage to skeletal muscle when injected intramuscularly, bupivacaine appears to have an exceptionally high rate of myotoxicity. Research has suggested that an effect of bupivacaine on sarcoplasmic reticulum Ca2+ release is involved in its myotoxicity, but direct evidence is lacking. Furthermore, it is not known whether the toxicity depends on the unique chemical characteristics of bupivacaine and whether the toxicity is found only in skeletal muscle.

Methods: The authors studied the effects of bupivacaine and the similarly lipid-soluble local anesthetic, tetracaine, on the Ca2+ release channel-ryanodine receptor of sarcoplasmic reticulum in swine skeletal and cardiac muscle. [(3) H]Ryanodine binding was used to measure the activity of the Ca2+ release channel-ryanodine receptors in microsomes of both muscles.

Results: Bupivacaine enhanced (by two times at 5 mM) and inhibited (66% inhibition at 10 mM) [(3) H]ryanodine binding to skeletal muscle microsomes. In contrast, only inhibitory effects were observed with cardiac microsomes (about 3 mM for half-maximal inhibition). Tetracaine, which inhibits [(3) H]ryanodine binding to skeletal muscle microsomes, also inhibited [(3) H]ryanodine binding to cardiac muscle microsomes (half-maximal inhibition at 99 [micro sign]M).