Following a single subcutaneous dose of 9 mg/kg and 18 mg/kg NOCITA, median time to reach Cmax was rapid (0.5 hr) but it was delayed significantly at a high dose of 30 mg/kg (60 hr). Following equivalent doses (9 mg/kg) of NOCITA and bupivacaine HCl solution, the mean bupivacaine AUC(0-72) and Tmax were comparable. However, due to the slow release mechanism of the NOCITA formulation, the mean Cmax and T½ were approximately 3-fold lower and 3.5-fold higher, respectively. Following an increase in dose of NOCITA, the bupivacaine pharmacokinetics was nonlinear with high variability in exposure parameters. Both Cmax and AUC(0-72) increase with dose but the increases were less than dose proportional. Further, the non-linear bupivacaine pharmacokinetics was made evident by an increase in the terminal phase half-life with the increase in dose.
Effectiveness was demonstrated in a multi-center, placebo-controlled, randomized and masked field study in client-owned dogs undergoing cranial cruciate ligament stabilization surgery. In this study, 182 dogs were enrolled in the study and randomized to treatment with NOCITA (n = 123) or saline (placebo, n = 59). The per protocol population for effectiveness was 112 NOCITA treated dogs and 52 saline dogs.
Dogs received an opioid analgesic just prior to general anesthesia and surgery. Surgical repair technique was at the discretion of the surgeon, and included extra-capsular repair, tibial plateau leveling osteotomy (TPLO), or tibial tuberosity advancement (TTA).
Table D-3 shows the number and percent of surgical procedures by treatment group.
Table D-3. Surgical Procedure by Treatment Group
Using an infiltration injection technique, a single dose of NOCITA or saline was infiltrated into the tissue layers during surgical closure. NOCITA or saline was administered either as is or with the addition of up to an equal volume of sterile saline. Pain was assessed by trained observers using the Glasgow Composite Measure Pain Scale-Short Form (CMPS-SF) for up to 72 hours following surgical closure. Pain assessments were conducted prior to surgery, and at 0.5, 1, 2, 4, 8, 12, 24, 30, 36, 48, 56 and 72 hours post-surgery. Dogs with a CMPS-SF score ≥ 6 or were determined to be painful by the investigator received rescue analgesic medication and were classified as treatment failures. No further CMPS-SF pain assessments were recorded for dogs that received rescue analgesic medication. The primary variable for effectiveness was evaluated over the first 24-hour time interval. The percent of treatment success for NOCITA was significantly different from and greater than saline at the first 24-hour time interval (p = 0.0322). The 24-48 hour and 48-72 hour time intervals were evaluated as secondary variables and support effective use of NOCITA for up to 72 hours of analgesia.
Table D-4. Number and Percent Effectiveness for NOCITA and Saline (Placebo) at each Time Interval*