Phase Ia and Ib study of amitriptyline for ulnar nerve block in humans - Side effects and efficacy

Background: The antidepressant amitriptyline is used as an adjuvant in the treatment of chronic pain conditions. Among its many actions, this drug also blocks ion channels, such as Na+ channels. Preliminary animal studies suggested that amitriptyline would be a longer-lasting local anesthetic than bupivacaine, with potentially fewer side effects. Therefore, the authors investigated the adverse effects and effectiveness of this drug when given for ulnar nerve blockade in human volunteers. Methods: After obtaining written institutional review board approval and informed consent, a typical phase la trial was conducted by administration to the ulnar nerve at the level of the wrist in an open-label, dose-escalating fashion. Amitriptyline hydrochloride, 4 nil, at concentrations of 5, 10, and 20 mm (n = 4-9/group) was used for each volunteer. If no major side effects and nerve block were encountered, comparison in a randomized, double-blinded trial of amitriptyline (20 mm) to placebo and bupivacaine (4 mm) (n = 4-9/group), was to follow. A blunt needle was used to grade the pain, and motor blockade was assessed by the Froment test. Results: There was no significant statistical difference in terms of side effects (pain, swelling, erythema, and sedation) among any groups. The analgesic effects of 20 mm amitriptyline and 4 mM bupivacaine solution were significantly higher than those of the placebo solution. Conclusions: Because of the lack of evidence that amitriptyline provides better nerve blockade than current local anesthetics and the potential for neurotoxicity, its use for peripheral nerve blockade in humans seems limited.