Neurotoxicity of perineural vs intraneural-extrafascicular injection of liposomal bupivacaine in the porcine model of sciatic nerve block.
Liposomal bupivacaine is a prolonged-release local anaesthetic, the neurotoxicity of which has not yet been determined. We used quantitative histomorphometric and immunohistochemical analyses to evaluate the neurotoxic effect of liposomal bupivacaine after perineural and intraneural (extrafascicular) injection of the sciatic nerve in pigs. In this double-blind prospective randomised trial, 4 ml liposomal bupivacaine 1.3% was injected either perineurally (n = 5) or intraneurally extrafascicularly (n = 5). Intraneural-extrafascicular injection of saline (n = 5) was used as a control. After emergence from anaesthesia, neurological examinations were conducted over two weeks. After harvesting the sciatic nerves, no changes in nerve fibre density or myelin width indicative of nerve injury were observed in any of the groups. Intraneural injections resulted in longer sensory blockade than perineural (p < 0.003) without persistent motor or sensory deficit. Sciatic nerve block with liposomal bupivacaine in pigs did not result in histological evidence of nerve injury.
Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia.
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Damjanovska
Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Cvetko
NAICE (North American Institute for Continuing Education), New York, NY, USA.|NYSORA (The New York School of Regional Anesthesia), New York, NY, USA.|Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
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Hadzic
Clinic for Small Animal Medicine and Surgery, Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia.
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Seliskar
Clinic for Small Animal Medicine and Surgery, Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia.
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Plavec
Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Mis
Department of Anatomy, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
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Vuckovic Hasanbegovic
Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia.
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Stopar Pintaric
D000779:Anesthetics, Local / Q000633:toxicity*; D000818:Animals; D002045:Bupivacaine / Q000008:administration & dosage / Q000633:toxicity*; D005205:Fascia; D005260:Female; D007267:Injections; D008081:Liposomes; D008297:Male; D009407:Nerve Block / Q000009:adverse effects*; D012584:Sciatic Nerve / Q000187:drug effects* / Q000473:pathology; D013552:Swine
D000779:Anesthetics, Local; D008081:Liposomes; D002045:Bupivacaine