Peripheral nerve injury after local anesthetic injection

Scott J. Farber, Maryam Saheb-Al-Zamani, Lawrence Zieske, Osvaldo Laurido-Soto, Amit Bery, Daniel Hunter, Philip Johnson, Susan E. Mackinnon

Research output: Contribution to journalArticle

45 Scopus citations

Abstract

Background: A well-known complication of peripheral nerve block is peripheral nerve injury, whether from the needle or toxicity of the medication used. In this study, we sought to determine the extent of damage that results from intrafascicular injection of various commonly used local anesthetics (LAs). Methods: Sixteen Lewis rats received an intrafascicular injection of saline (control) or 1 of 3 LAs (bupivacaine, lidocaine, or ropivacaine) into the sciatic nerve (n = 4). At a 2-week end point, the sciatic nerves were harvested for histomorphometric and electron microscopic analysis. Results: Animals that received intrafascicular LA injections showed increased severity of injury as compared with control. In particular, there was a significant loss of large-diameter fibers as indicated by decreased counts (P < 0.01 for all LAs) and area (P < 0.01 for all LAs) of remaining fibers in severely injured versus noninjured areas of the nerve. There was a layering of severity of injury with most severely injured areas closest to and noninjured areas furthest from the injection site. Bupivacaine caused more damage to large fibers than the other 2 LAs. In all groups, fascicular transection injury from the needle was observed. Electron microscopy confirmed nerve injury. Conclusions: Frequently used LAs at traditional concentrations are toxic to and can injure the peripheral nerve. Any combination of motor and/or sensory sequelae may result due to the varying fascicular topography of a nerve.

Original languageEnglish (US)
Pages (from-to)731-739
Number of pages9
JournalAnesthesia and analgesia
Volume117
Issue number3
DOIs
StatePublished - Sep 1 2013
Externally publishedYes

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Fingerprint Dive into the research topics of 'Peripheral nerve injury after local anesthetic injection'. Together they form a unique fingerprint.

  • Cite this

    Farber, S. J., Saheb-Al-Zamani, M., Zieske, L., Laurido-Soto, O., Bery, A., Hunter, D., Johnson, P., & Mackinnon, S. E. (2013). Peripheral nerve injury after local anesthetic injection. Anesthesia and analgesia, 117(3), 731-739. https://doi.org/10.1213/ANE.0b013e3182a00767