INTRODUCTION AND OBJECTIVES: The purpose of this study is to investigate the cytotoxic potency of bupivacaine, a commonly used local anesthetic, on primary patient-derived sarcoma cells.

METHODS: Multiple sarcoma subtypes were evaluated in this study including: a high-grade conventional osteosarcoma (OS), a high-grade undifferentiated pleomorphic sarcoma of bone (UPS), and a high-grade synovial sarcoma (SS).

All tumor cells were harvested from patients during resection.

The tumor cells were exposed to various concentrations of preservative free bupivacaine for various durations with pH balanced saline as a control.

Tumor cell viability and apoptosis induction were evaluated by MTT assay and flow cytometry.

RESULTS: Exposure to bupivacaine decreased cell viability and induced apoptosis, which was confirmed by cell morphology and annexin+ cells in all sarcoma subtypes, in a dose-and time-dependent manner.

At clinically relevant doses, in vitro exposure to bupivacaine caused a decrease in cellular viability and an increase in the induction of apoptosis in a dose-and time-dependent manner in each of the tumor cells evaluated in this study.

CONCLUSIONS: These findings have potential clinical relevance in the management of patients with sarcoma. Consideration should be given tousing bupivacaine while performing biopsies to decrease the risk of biopsy tract contamination. There may also be consideration for use as an adjuvant or neoadjuvant treatment during tumor resectionin the form of local delivery via injection or infusion using a pain pump with a catheter placed in the tumor bed. A Bier block or isolated limb perfusion could be used for sarcomas of the extremity.



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