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Peripheral nerve injection injury with antiemetic agents
J E Strasberg1, A Atchabahian, S R Strasberg
1Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Journal of Neurotrauma
|February 16, 1999
Summary
Intramuscular antiemetic injections can cause nerve injury. Prochlorperazine demonstrated less neurotoxicity in rat sciatic nerve models compared to promethazine and dimenhydrinate, suggesting it may be safer for intramuscular use.
Area of Science:
- Neuroscience
- Pharmacology
- Toxicology
Background:
- Antiemetics are frequently used to manage nausea and vomiting.
- Systemic administration of antiemetics does not cause peripheral neurotoxicity.
- The risk of peripheral nerve injury from inadvertent intraneural injection of antiemetics is unknown.
Purpose of the Study:
- To investigate the neurotoxic effects of three common antiemetics: promethazine, dimenhydrinate, and prochlorperazine.
- To compare the neurotoxicity of these agents against saline in a rat sciatic nerve model.
- To evaluate injury from intraneural and extraneural injections, as well as direct drug application.
Main Methods:
- Intrafascicular and extrafascicular injections of antiemetics and saline into rat sciatic nerves.
- Direct application of antiemetic drugs to nerves.
- Histological and morphometric analysis of nerve tissues at 2 and 8 weeks post-injection.
Main Results:
- Extrafascicular injections and direct drug application did not cause nerve damage.
- Intrafascicular injection of promethazine and dimenhydrinate resulted in diffuse axonal injury.
- Intrafascicular injection of prochlorperazine caused only focal axonal injury.
- Significant nerve regeneration was observed by 8 weeks in all intrafascicular injection groups.
Conclusions:
- Antiemetic drugs can cause peripheral nerve injury upon inadvertent intraneural injection.
- Prochlorperazine exhibits lower intraneural neurotoxicity compared to promethazine and dimenhydrinate.
- Prochlorperazine is recommended for intramuscular administration due to its reduced neurotoxic potential.