Intrafascicular application of Lidocaine 2% or 0.9% NaCl into median nerve of the rat

Ilvana Hasanbegović, Eldan Kapur, Lejla Dervišević, Amela Dzubur-Alic, Alen Dzubur

Abstract


Background: Intraneural (intrafascicular) injection of various solutions can result in a mechanical injury to the fascicle(s). Additional injury can be expected when injectate has neurotoxic properties. In this study we examined the neurologic consequences of intraneurally injected lidocaine 2% and 0.9% NaCl. We postulated that intraneural injection of lidocaine 2% results in greater and longer-acting neurologic deficit in rats compared to intraneural injection of 0.9% NaCl.

Methods and Materials: The study was conducted in accordance with the principles of laboratory animal care and was approved by the Laboratory Animal Care and Use Committee. Twenty four adult Wistar rats (300 g) both sexes were studied. After induction of general anesthesia (ether), the median nerve was exposed bilaterally. Under direct vision, a 27-gauge needle was placed either perineurally (n=24) or intraneurally (n=24), and 3 mL of preservative-free lidocaine 2% or 0.9% was injected using an automated infusion pump (3ml/min). Injection pressure data were acquired using an in-line manometer coupled to a computer via an analog-to-digital conversion board. After injection, the rats were awakened and subjected to serial neurologic examinations. Neurologic examination protocol was followed to determine grip strength and toe pinch reaction. Day 7 of the experiment, the animals were sacrificed and the neural tissue histologically examined.

Results: Over the week following the procedure, all animals in both injection protocols (intraneural and perineural) initially lost and subsequently regained grip strength and paw pinch withdrawal reflex. Animals in the perineural group fully recovered grip strength and toe pinch score within 24-hours of surgery; the saline group showed more rapid recovery. In contrast, neither the lidocaine 2% or 0.9% saline intraneural group fully recovered a grip strength or toe pinch until the 7th or 4th day of recovery, respectively. There were no differences in the extent of neurologic impairment or speed of recovery between the saline and lidocaine 2% groups. Post-hoc comparisons of the four injection group by treatment condition effect at each testing interval post-surgery showed superior recovery in the perineural injected preparations at all intervals tested after hour 4 (p < 0.001). The average peak pressure for the intraneural injection group was 80.96 ± 20.94 kPa versus 21.63 ± 5.58 kPa for the perineural injection group (p < 0.0001). Histologic features of the injured tissues ranged from perineural ablation, cellular infiltration to destruction of neural architecture and axonal degeneration in intraneural preparations. No differences in this regard were found between lidocaine 2% and saline 0.9% groups.

Conclusions: Intraneural injection of lidocaine 2% or 0.9% NaCl result in an indistinguishable neurologic deficit that is similar both in extent and duration. Intraneural injection is associated with significantly higher injection pressure as compared to the perineural injection. These results suggest that the main mechanism of neurologic injury resulting from an intraneural injection of lidocaine 2% may be a mechanical, injury to the fascicle(s), rather than a direct neurotoxicity.


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Hadzic A. Dilberovic F. Shah S. Kulenovic A. Kapur E. Zaciragic A. Cosovic E. Vuckovic I. Divanovic KA. Mornjakovic Z. Thya DM. Santos AC. Combination of intraneural injection and high injection pressure leads to fascicular injury and neurologic deficit in dogs. Regional Anesthesia and Pain Medicine. 2004; 29(5): 417-423.

Sawyer RJ. Richmond MN. Hickey JD. Jarrratt JA. Peripheral nerve injuries associated with anaesthesia. Anaesthesia. 2000; 55: 980-991.

Chambers WA. Peripheral nerve damage and regional anesthesia. Br J Anaesth. 1992; 69: 429-30.

Hasanbegovic I. Kapur E. Kulenovic A. Gojacic A. Dzubur A. Musanovic J. Detection of nerve structures during peripheral nerve blockade in pigs model. Archives of Pharmacy Practice. 2013; 4(2): 51- 56.

Hasanbegovic I. Kapur E. Ćosović E. Kulenovic A. Mornjaković Z. Blockade of peripheral nerves and prevention of unwanted consequences. Homo Sporticus. 2012; 1: 17-21.

Farber SJ. Saheb-Al-Zamani M. Zieske L. Laurido-Soto O. Bery A. Hunter D. Johnson P. Mackinnon SE. Peripheral nerve injury after local anesthetic injection. Anesth Analg. 2013;117(3):731-9.

National Institutes of Health. Principles of Laboratory Animal Care. National Institutes of Health publication No. 86-23. Bethesda, MD: National Intitutes of Health, 1985.

Thalhammer JG. Vladimirova M. Bershadshy B. Strichartz GR. Neurologic evaluation of the rat during sciatic nerve blok with lidocaine. Anesthesiology. 1995; 82: 1013-25.

Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988: 179-214.

Verlinde M. Hollmann MW. Stevens MF. Hermanns H. Werdehaussen R. Lirk P. Local anesthetic-induced neurotoxicity. Int J Mol Sci. 2016; 17(3): 339.

Nau C. Wang GK. Interaction of local anesthetics with voltage-gated Na+ channels. J membr Biol. 2004; 201; 1-8.

Sun Y. Li T.Wang N. Yun Y. Gan TJ. Perioperative systemic lidocaine for postoperative analgesia and recovery after abdominal surgery: A Meta- analysis of randomized controlled trials. Dis Colon Rectum. 2012; 55: 1183-1194.

Auroy Y. Benhamou D. Bargues L. Ecoffey C. Falissard B. Mercier FJ. Bouaziz H. Samii K. Mercier F. Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service. Anesthesiology. 2002; 97; 1274-80.

Dippenaar JM. Local anaesthetic toxicity. SAJAA. 2007; 13(3): 23-28.

Denny Brown D. Doherty MM. Effects of transient streching of peripheral nerves. Archives of Neurology and Psychiatry. 1945; 116-29.

Mackinnon SE. Hudson AR. Bojanowski V. Hunter DA. Maraghi E. Peripheral nerve injection injury with purified bovine collagen-an experimental model in rat. Ann Plast Surg. 1985; 14: 428-36.

Iohom G. Lan GB. Diarra DP. Grignon Y. Kinirons BP. Girard F. Merle M. Granier G. Cahn V. Bouaziz H. Long-term evaluation of motor function following intraneural injection of ropivacaine using walking track analysis in rats. Br J Anaesth. 2005; 94(4): 524-9.

Kapur E. Neurologic and histologic outcome after intraneural injections of lidocaine in canine sciatic nerves. Acta Anaesthesiol Scand. 2007; 51(1): 101-7.

Selander D. Peripheral nerve injury caused by injection needles. Br J Anesth. 1993; 71(2): 323-5.

Kapur E. Hasanbegovic I. Šahinović M. Kulenović A. Lujinović A. Neurologic outcome after intraneural and perinerula sciatic nerve block in pigs. Veterinaria. 2012; 61(3-4): 161- 167.

Sala-Blanch X. Vanderpitte C. Laur JJ. Horan P. Xu D. Reina MA. Karmakar MK. Clark TB. Hadzic A. A practical review of perineural versus intraneural injections: A call fos standard nomenclature. Int Anesthesiol Clin. 2011; 49(4): 1-12.

Gilliatt RW. Harrison MJG. Nerve compression and entrapment. In: Asbury AK. Gilliatt RW.eds. Peripheral Nerve Damage, a Practical Approach. London: Butterworth. 2004: 245.

Nicholson MJ. Eversole UH. Nerve damage incident to anaesthesia and operations. Anesthesia and Analgesia. 1957; 36(4): 19-32.

Butterworth JF. Strichartz GR. Molecular mechanisms of local anaesthetics: a review. Anesthesiology. 1990; 72: 711-34.

Burkel WE. McPhee M. Effect of phenol injection into peripheral nerve of rat: Electron microscope studies. Arch Phys Med Rehabil. 1970; 51: 391-397.

Holbrook TJ. Pilsher C. The effects of injection of pencillin, peanut oil and beewax, separately and in combination, upon nerve and muscle: An experimental study. Surg Gynecol Obstet. 1950; 90: 39-44.

Mackinnon SE. Hudson AR. Gentili F. Kline DG. Hunter RT. Peripheral nerve injury with steroid agents. Plast Reconstr Surg. 1982; 69: 482-489.

Mackinnon SE. Hudson AR. Llamas F. Dellon AL. Kline DG. Hunet RT. Peripheral nerve injury by chymopapain injection. J Neurosurg. 1984; 61: 1-8.

Strasberg JE. Atchabahian A. Strasberg SR. Watanabe O. Hunter DA. Mackinnon SE. Peripheral nerve injection injury with antiemetic agents. J Neurotrauma 1999; 16: 99-107.

Gentili F. Hudson RA. Hunter D. Kline GD. Nerve injection injury with local anesthetic agents. A light and electron microscopic and horseradish peroxide study. Neruosurgery. 1980; 6(3): 263-272.

Pizzolato P. Renegar JO. Histopathologic effect of long exposure to local anesthetics on peripheral nerves. Aneth Anal. 1959; 38(2): 138-141.

Whiting DJ. Williams BA. Orebaught SL. Case report postoperative analgesia and preserved motor function with clonidine and buprenorphine via a sciatic perineural catheter. J Clin Anesth. 2009; 21: 297-299.

Myers RR. Kalichman MW. Reisner Ls. Powell HC. Neurotoxicity of local anestthetics: altered perineural permeability, edema, and nerve fiber injury. Anesthesiology. 1986; 64: 29-35.

Gentili F. Hudson A. Kline D. Hunter D. Early changes following injection injury of peripheral nerves. Can J Surg. 1980; 23: 177-182.

Upton AR. McComas AJ. The double crush in nerve entrapment syndromes. Lancet. 1973. 2: 359-362.


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