Key Words:
centbucridine, local anesthesia
Almost after a century of its introduction, local anesthesia
remains one of the most important methods to relieve pain in
perioperative medicine. They can find their uses in different
forms, i.e. as part of general anesthesia, in regional
anesthesia, in plexus block or as local infiltration
anesthesia itself.
Many local anesthetics have been introduced since 1884, from
cocaine, which was administered on eye as a local anesthetic
to relatively newer drugs like ropivacaine, levo-bupivacaine,
etc.; having their own advantages and disadvantages.
Research always looks forward to find a drug with better
safety profile in terms of cardiovascular (CV) and Central
Nervous System (CNS) toxicity, with enhanced anesthetic
efficiency and with increased nociceptive selectivity.
Central Drug Research Institute, Lucknow, formulated a new
drug called centbucridine (by Patnaik et al[3]) in 1983. This
new drug came into existence because of the need of a drug
that offers better safety profile and less side effects.
Local anesthetics generally belong to either amide or ester
group. However, centbucridine doesn't belong to either of
them. It is a quinolone derivative, its IUPAC nomenclature [3]
being 4-N-butylamino-1,2,3,4-tetrahydroacridine hydrochloride.
Because of its safety profile, centbucridine [1-3] is used
extensively in various procedures as an infiltrator, nerve
blocks, subarachnoid blocks 0.5%, intravenous regional
anesthesia, etc. It is also used as a topical anesthetic in
ophthalmic surgeries. Various studies were done comparing
centbucridine and lignocaine. Centbucridine was found to be 4
to 5 times more potent than lignocaine. The onset of action of
centbucridine was much quicker (14 seconds more [3]) and the
action of centbucridine persisted longer than lignocaine.
Lignocaine [1] and bupivacaine are associated with CNS and CV
toxicity, respectively. On the other hand, centbucridine was
found to be safer as it does not affect CNS and CV parameters,
except when very high dosage is used.
The most important advantage of centbucridine is that it can
be given without adrenaline because of its vasoconstrictor
property. Hence, it can be given in conditions where there is
contraindication [4] to adrenaline. Moreover, it can also be
given in conditions where there is hypersensitivity to
lignocaine.
Thus, it can be said that centbucridine is a new, promising
drug with better safety profile. More research as well as
clinical trials has to be done to prove its worth in day to
day anesthetic practice.
References
1. Mansuri S ,Bhayat A, Omar E, Jarab F, Ahmed MS. A
randomized controlled trial comparing the efficacy of 0.5%
centbucridine to 2% lignocaine as local anaesthetic in dental
extraction. Int J Dent. 2011;2011:795047.
2. Ghose S, Biswas NR, Das GK, Sethi A, Venna B, Jhingan S,
Pandey RM. A prospective randomized double masked controlled
clinical trial to determine the efficacy of multiple drop
centbucridine as an ocular surface anaesthetic. Indian J
Physiol Pharmacol. 2004;48:466-70.
3. Suri YV, Patnaik GK, Nayak BC, Gupta PP, Singh D, Dhawan
BN. Evaluation of centbucridine for intravenous regional
anaesthesia. Indian J Med Resp.1983;77:722-7.
4. Dugal A, Khanna R, Patankar A. A comparative study between
0.5% centbucridine HCL and 2% Lignocaine HCL with
adrenaline(1:200,000). J Maxill fac Oral Surg. 2009;8:21-3.