A Pilot Study to Investigate the Effects of Bupivacaine Nasal Treatment in Palliative Care Patients with Swallowing Difficulty.

Dysphagia among end-of-life patients in palliative care is debilitating and requires symptomatic management. Current methods involving usage of IV fluids, total parenteral nutrition, intermittent oral liquid feeds, use of naso-gastric tubes or administration of nasal saline drops are inadequate in providing relief to the patient, warranting exploration of newer methods. At SSCHRC, a novel intervention of intranasal administration of Bupivacaine, a widely used anesthetic has been used successfully to treat end-of-life cancer patients, providing temporary relief for about half an hour with each administration, facilitating food and water intake. This study is aimed as a pilot to assess the feasibility of the study design in gathering molecular data on the effect of the treatment, especially on the mucin related pathways. Using throat swabs of patients, we obtained bulk RNAseq transcriptomes before and after the treatment. We analyze patterns of differential expression and use a genome-wide protein-protein interaction network approach to infer the affected pathways and processes. Our results indicate that the Bupivacaine treatment shows variation in gene expression in key genes and pathways that could potentially explain reduction in mucin secretion leading to relieving symptoms of dysphagia. It provides support for conducting a larger clinical study in order to study the effect in a larger cohort.