Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2008 Sep-Oct;33(5):435-41.
doi: 10.1016/j.rapm.2008.03.002.

Pathophysiology of peripheral nerve injury during regional anesthesia

Quinn H Hogan  1
Affiliations
Review

Pathophysiology of peripheral nerve injury during regional anesthesia

Quinn H Hogan. Reg Anesth Pain Med. 2008 Sep-Oct.

Abstract

Background and objectives: Despite attention to technical details in performance of regional anesthetics, damage to nerves continues to be a concern. Understanding of pathophysiological mechanisms may aid in decreasing the incidence and severity of such injuries.

Methods: Studies from both clinical and basic science perspective are reviewed.

Results: Exposure of peripheral nerves to local anesthetics may result in axonal damage, particularly if the solution is injected intrafascicularly, if the concentration is high, and if duration of exposure is prolonged. Disruption of numerous cellular functions may contribute to neuronal damage by local anesthetics, but elevated intracellular calcium levels may play a central role. Needle penetration of a nerve results in minimal lasting damage unless this is combined with local anesthetic administration within the nerve fascicle. Direct compression by a pronged tourniquet application may damage axons particularly of large myelinated fibers. Ischemia may also contribute to neuronal injury in proportion to the duration of blood flow interruption.

Conclusions: The relative importance of these pathogenic factors in cases of nerve injury after regional anesthesia is not resolved.

PubMed Disclaimer

Figures

Figure 1
Figure 1
See this image and copyright information in PMC

References

    1. Sturrock JE, Nunn JF. Cytotoxic effects of procaine, lignocaine and bupivacaine. Br J Anaesth. 1979;51:273–280. - PubMed
    1. Myers RR, Kalichman MW, Reisner LS, Powell HC. Neurotoxicity of local anesthetics: altered perineurial permeability, edema, and nerve fiber injury. Anesthesiology. 1986;64:29–35. - PubMed
    1. Barsa J, Batra M, Fink BR, Sumi SM. A comparative in vivo study of local neurotoxicity of lidocaine, bupivacaine, 2- chloroprocaine, and a mixture of 2-chloroprocaine and bupivacaine. Anesth Analg. 1982;61:961–967. - PubMed
    1. Powell HC, Kalichman MW, Garrett RS, Myers RR. Selective vulnerability of unmyelinated fiber Schwann cells in nerves exposed to local anesthetics. Lab Invest. 1988;59:271–280. - PubMed
    1. Kalichman MW, Powell HC, Myers R. Pathology of local anesthetic-induced nerve injury. Acta Neuropathol. 1988;75:583–589. - PubMed

MeSH terms

Substances