Intrathecal mepivacaine and prilocaine are less neurotoxic than lidocaine in a rat intrathecal model.
OBJECTIVE
Histologic evidence of the comparative neurotoxicity of lidocaine, mepivacaine, and prilocaine is incomplete. We compared the intrathecal neurotoxicity in rats among these 3 drugs based on morphologic and neurofunctional findings.


METHODS
Rats (n=169) randomly received 0.12 microL/g of 0%, 2%, 5%, 7.5%, 10%, or 20% lidocaine, mepivacaine, or prilocaine or 25% glucose dissolved in distilled water via a chronically implanted intrathecal catheter. The effect of the agents on neurofunction was evaluated by movement of the hind limb (behavior test) and by sensory threshold (paw-stimulation test). The L1 spinal cord, the posterior and anterior roots, and the cauda equina were removed en bloc 5 days later and examined by light and electron microscopy.


RESULTS
A significant decrease in sensory threshold or irreversible hind-limb limitation was observed only in rats receiving 20% lidocaine. Morphologic abnormalities characterized by axonal degeneration were observed in rats receiving > or =7.5% lidocaine, 20% mepivacaine, and 20% prilocaine, at the posterior white matter and the proximal portion of the posterior root just at the entrance into the spinal cord. The incidence of lesions was significantly higher in rats receiving lidocaine than mepivacaine and prilocaine.


CONCLUSIONS
It is suggested that intrathecal mepivacaine and prilocaine are less neurotoxic than highly concentrated lidocaine in a rat intrathecal model.
Takenami
Tamie
T
Department of Anesthesiology, Kitasato University School of Medicine, Kanagawa, Japan. takenami@med.kitasato-u.ac.jp
Yagishita
Saburo
S
Nara
Yoshihiro
Y
Hoka
Sumio
S
D000779:Anesthetics, Local / Q000008:administration & dosage / Q000633:toxicity*; D000818:Animals; D001522:Behavior, Animal / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D006863:Hydrogen-Ion Concentration; D007278:Injections, Spinal / Q000379:methods; D008012:Lidocaine / Q000008:administration & dosage / Q000633:toxicity*; D008297:Male; D008619:Mepivacaine / Q000008:administration & dosage / Q000633:toxicity*; D023421:Models, Animal; D009068:Movement / Q000187:drug effects; D020258:Neurotoxicity Syndromes; D009994:Osmolar Concentration; D011318:Prilocaine / Q000008:administration & dosage / Q000633:toxicity*; D051381:Rats; D017208:Rats, Wistar; D012684:Sensory Thresholds / Q000187:drug effects; D013116:Spinal Cord / Q000187:drug effects / Q000648:ultrastructure; D013997:Time Factors
D000779:Anesthetics, Local; D011318:Prilocaine; D008012:Lidocaine; D008619:Mepivacaine