In vivo determination of concentration-effect curves of local anaesthetics in man

In clinical use, the concentrations of local anaesthetics at the site of action are unknown. With the method described here, concentrations of local anaesthetics can be predetermined and kept constant at the site of action. In six volunteers, a blister was raised on the ventral surface of the forearm. After removal of the epithelium, the blister base was rinsed continuously with carbogenated Tyrode's solution with and without increasing concentrations of bupivacaine (Carbostesin) for 15 min each. The effects of bupivacaine were determined by changes in the perception (tactile sensation) of drops falling on the blister base from increasing heights. The minimal height at which the drops were just perceived characterized the threshold of perception. With increasing bupivacaine concentrations, threshold increased until the drops were no longer perceived, at a median concentration of 2.48 mmol litre-1 (range 1.24-3.10 mmol litre-1). After the blister base was rinsed with Tyrode's solution, threshold of perception reached baseline values, which was in accordance with an intact blister base.