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Neurotoxicity of Local AnestheticsAltered Perineurial Permeability, Edema, and Nerve Fiber Injury

 

作者: Robert Myers,   Michael Kalichman,   Laurence Reisner,   Henry Powell,  

 

期刊: Anesthesiology  (OVID Available online 1986)
卷期: Volume 64, issue 1  

页码: 29-35

 

ISSN:0003-3022

 

年代: 1986

 

出版商: OVID

 

关键词: Anesthetics;local: bupivacaine; chloroprocaine; lidocaine; tetracaine;Nerve: injury;Toxicitv: local anesthetics

 

数据来源: OVID

 

摘要:

A quantitative, in situ experimental method was developed employing the rat sciatic nerve to study the neurotoxicity of local anesthetic solutions applied directly to an intact peripheral nerve bundle. One-milliliter volumes of 2-chloroprocaine, 3%; tetracaine, 1 %; lidocaine, 2%; bupivacaine, 0.75%; or sodium chloride, 0.2%; were injected with a 30-gauge needle beneath the mesoneurium but exterior to the epineurium. The wound was closed and the animals were normally maintained until the nerves were reexposed for quantitative biophysical and morphologic testing 24 h to 4 weeks later. The results indicate that topically applied 2-chloroprocaine and tetracaine produce significant endoneurial edema 48 h after treatment. Horseradish peroxidase was used to verify increased permeability of the perineurium. Endoneurial fluid pressure was significantly increased in edematous nerves. Electron microscopy revealed abnormal mast cells and proliferation of endoneurial fibro-blasts in addition to Schwann cell injury and axonal dystrophy. This study shows that extrafascicular administration of clinically used concentrations of local anesthetic solutions can alter perineurial permeability, producing changes in the endoneurial environment that are associated with neurotoxic injury. Perineurial and endoneurial fibrolic changes may be a late consequence of peripheral nerve injury with anesthetic solutions producing altered perineurial permeability with endoneurial edema.

 

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