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Peripheral nerve injury after local anesthetic injection
Scott J Farber1, Maryam Saheb-Al-Zamani, Lawrence Zieske
1From the Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, Missouri.
Anesthesia and Analgesia
|August 8, 2013
Summary
Common local anesthetics (LAs) cause peripheral nerve injury when injected directly into nerves. Bupivacaine, lidocaine, and ropivacaine all damaged nerve fibers, with bupivacaine causing the most severe injury to large fibers.
Area of Science:
- Neuroscience
- Anesthesiology
- Toxicology
Background:
- Peripheral nerve injury is a known complication of peripheral nerve blocks.
- Causes include needle trauma and local anesthetic (LA) toxicity.
Purpose of the Study:
- To assess the extent of peripheral nerve damage from intrafascicular injection of common LAs.
- To compare the neurotoxicity of bupivacaine, lidocaine, and ropivacaine.
Main Methods:
- Intrafascicular injection of saline, bupivacaine, lidocaine, or ropivacaine into the sciatic nerve of Lewis rats.
- Histomorphometric and electron microscopic analysis at a 2-week endpoint.
Main Results:
- Intrafascicular LA injection significantly increased nerve injury severity compared to saline.
- All LAs caused a significant loss of large-diameter nerve fibers.
- Bupivacaine induced more severe damage to large fibers than lidocaine or ropivacaine.
- Needle-induced fascicular transection was observed in all groups.
Conclusions:
- Commonly used LAs are neurotoxic and can cause peripheral nerve injury.
- Nerve injury severity depends on LA type and concentration, and proximity to the injection site.
- Damage to nerve fascicles can lead to varied motor and sensory deficits.
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