18 Participants Needed

Intralipid® 20% for Local Anesthetic Reversal

MP
JL
Overseen ByJustas Lauzadis, PhD
Age: 18+
Sex: Any
Trial Phase: Phase 4
Sponsor: Hospital for Special Surgery, New York
Prior Safety DataThis treatment has passed at least one previous human trial
Approved in 3 JurisdictionsThis treatment is already approved in other countries

What You Need to Know Before You Apply

What is the purpose of this trial?

In order to determine if Intralipid 20% can be used to reverse the effects of local anesthetics, the investigators will recruit 18 volunteers who will be asked to come to HSS for two study visits. Small amounts of local anesthetics will be injected into the volunteers' thighs during both visits. During one visit volunteers will receive Intralipid 20% and during the other visit they will receive a saline solution. The study team will measure how quickly normal sensation returns to the thighs when the volunteers get Intralipid 20% compared to saline.

Will I have to stop taking my current medications?

The trial requires that you do not use drugs that affect the sensorium, such as opioids, benzodiazepines, antipsychotics, and gabapentinoids.

Is Intralipid® 20% safe for use in humans?

Intralipid® 20% has been used safely in humans to treat toxicities from local anesthetics and other drugs, with case reports showing successful outcomes in reversing drug overdoses. It is considered a standard treatment for severe local anesthetic toxicity, suggesting a favorable safety profile in these contexts.12345

How does Intralipid® 20% differ from other treatments for local anesthetic toxicity?

Intralipid® 20% is unique because it acts as a 'lipid sink' to absorb and neutralize local anesthetics in the bloodstream, which is different from traditional resuscitation methods that do not specifically target the anesthetic itself. This lipid emulsion is administered intravenously and is particularly used when other treatments fail to reverse the toxicity.34567

What data supports the effectiveness of the drug Intralipid 20% Solution for reversing local anesthetic toxicity?

Intralipid 20% Solution has been shown to be effective in treating local anesthetic toxicity, as it is recommended as a first-line treatment by several international anesthesia organizations. Additionally, case reports have documented successful reversal of local anesthetic-induced toxicity using Intralipid, and it has also been effective in treating toxicities from other drug classes.13678

Who Is on the Research Team?

SM

Stavros Memtsoudis, MD/PhD

Principal Investigator

Hospital for Special Surgery, New York

Are You a Good Fit for This Trial?

This trial is for healthy English-speaking volunteers with a BMI of 18-25 and body weight between 50-100kg. It's not suitable for pregnant women, those with significant medical conditions (ASA III or higher), allergies to lidocaine, bupivacaine, soybeans, eggs, or those using drugs that affect the senses like opioids.

Inclusion Criteria

English speaking
My BMI is between 18-25 and I weigh between 50-100kg.

Exclusion Criteria

I am currently taking medication that affects my awareness or consciousness.
ASA III or higher
You are pregnant.
See 1 more

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive injections of local anesthetics and either Intralipid 20% or saline during two study visits

2 visits
2 visits (in-person)

Follow-up

Participants are monitored for the return of normal sensation after treatment

up to 24 hours

What Are the Treatments Tested in This Trial?

Interventions

  • Intralipid® 20% Solution
Trial Overview The study tests if Intralipid® 20%, an intravenous fat emulsion, can reverse numbness from local anesthetics faster than saline solution. Volunteers will receive small doses of local anesthetics in their thighs and then either Intralipid® or saline to compare recovery times.
How Is the Trial Designed?
2Treatment groups
Experimental Treatment
Placebo Group
Group I: Intralipid 20% IV BolusExperimental Treatment6 Interventions
This is 1 out of the 2 study visits. The patient will receive 6 injections (3 in each thigh). The 6 injections are: 1. lidocaine 1% 2. lidocaine 2% 3. bupivacaine 0.5% 4. bupivacaine 0.25% 5. saline 6. no injection Each test solution will be injected over 5 seconds through a 27G needle and tuberculin syringe at a 30 degree angle. The patient will also receive an intravenous bolus in the arm of Intralipid 20%. Participant will be blindfolded for these activities so they will not know what they received during the visit.
Group II: SalinePlacebo Group6 Interventions
This is 2 out of the 2 study visits. The patient will receive 6 injections (3 in each thigh). The 6 injections are: 1. lidocaine 1% 2. lidocaine 2% 3. bupivacaine 0.5% 4. bupivacaine 0.25% 5. saline 6. no injection Each test solution will be injected over 5 seconds through a 27G needle and tuberculin syringe at a 30 degree angle. The patient will also receive an intravenous bolus in the arm of Saline. Participant will be blindfolded for these activities so they will not know what they received during the visit.

Find a Clinic Near You

Who Is Running the Clinical Trial?

Hospital for Special Surgery, New York

Lead Sponsor

Trials
257
Recruited
61,800+

Published Research Related to This Trial

A survey of 36 anesthesiology departments in China revealed that only 22% had intravenous lipid emulsions readily available for treating Local Anesthetic Systemic Toxicity (LAST), despite it being a recommended first-line treatment.
Among the departments with lipid emulsion, 11 patients were successfully resuscitated from LAST, indicating that while the treatment is effective, its limited availability highlights a need for increased adoption and awareness of lipid rescue therapy in China.
Regional anesthesia and lipid resuscitation for local anesthetic systemic toxicity in China: results of a survey by the orthopedic anesthesia group of the Chinese Society Of Anesthesiology.Xu, M., Jin, S., Li, Z., et al.[2018]
In a study involving 60 rats, Intralipid (LCT emulsion) was found to be more effective than Lipovenoes (LCT/MCT emulsion) in reversing cardiac arrest caused by bupivacaine, with fewer instances of repeated asystole after resuscitation.
The LCT emulsion also resulted in lower plasma and myocardial bupivacaine concentrations, suggesting it may be a safer option for treating bupivacaine-related cardiotoxicity.
Lipid resuscitation of bupivacaine toxicity: long-chain triglyceride emulsion provides benefits over long- and medium-chain triglyceride emulsion.Li, Z., Xia, Y., Dong, X., et al.[2013]
Intralipid, a 20% lipid emulsion, has been suggested as a potential treatment for local anesthetic toxicity, especially when traditional resuscitation methods fail.
A case report demonstrated a positive response in a patient experiencing local anesthetic toxicity after receiving Intralipid, highlighting its potential efficacy in such critical situations.
The successful use of intralipid for treatment of local anesthetic-induced central nervous system toxicity: Some considerations for administration of intralipid in an emergency.Espinet, AJ., Emmerton, MT.[2013]

Citations

Regional anesthesia and lipid resuscitation for local anesthetic systemic toxicity in China: results of a survey by the orthopedic anesthesia group of the Chinese Society Of Anesthesiology. [2018]
Lipid resuscitation of bupivacaine toxicity: long-chain triglyceride emulsion provides benefits over long- and medium-chain triglyceride emulsion. [2013]
The successful use of intralipid for treatment of local anesthetic-induced central nervous system toxicity: Some considerations for administration of intralipid in an emergency. [2013]
Clinical applications of intravenous lipid emulsion therapy. [2018]
The effect of lipid emulsion infusion on postmortem ropivacaine concentrations in swine: endeavoring to comprehend a soldier's death. [2018]
Intravenous lipid emulsion for treatment of local anesthetic toxicity. [2021]
A mixed (long- and medium-chain) triglyceride lipid emulsion extracts local anesthetic from human serum in vitro more effectively than a long-chain emulsion. [2013]
Effect of Intralipid® on the Dose of Ropivacaine or Levobupivacaine Tolerated by Volunteers: A Clinical and Pharmacokinetic Study. [2022]
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