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Comparison of Myotoxic Effects of Lidocaine with Epinephrine in Rats and Humans

John A. Yagiela, DDS, PhD^*, Peter W. Benoit, DMD, PhD^*, Ralph D. Buoncristiani, DDS, Margaret P. Peters, MD, and Nelson F. Fort, DDS

*Associate Professor, Department of Oral Biology, Emory University School of Dentistry, Atlanta, Georgia Resident in Oral and Maxillofacial Surgery, University of California at Los Angeles, Los Angeles, California Chief of Anesthesia Service, Veterans Administration Hospital, Atlanta, Georgia Resident in Oral and Maxillofacial Surgery, Louisiana State University, New Orleans, Louisiana

Abstract

Myotoxic effects of 2% lidocaine with 1:100,000 epinephrine were evaluated in rats and humans. Sprague-Dawley rats were given injections in the left gastrocnemius muscle of 0.5 ml of the lidocaine preparation or a control vehicle; they were killed in groups of four at 0, 8, 24, and 48 hours. Blood samples were taken for serum enzyme determinations, and muscle specimens were removed and processed for histologic evaluation. In eight patients undergoing radical neck dissection, 1.8 ml of lidocaine with epinephrine or its control was injected into the sternocleidomastoid muscle approximately 18 hours before surgery. Patients' muscle specimens obtained at surgery were handled similarly to those of the rat. Serum creatine kinase, aspartate aminotransferase, and alanine aminotransferase activities were markedly elevated in the rat at 8 hours in the experimental group, but not in the control group. Histologically, control injections elicited no damage in the rat other than a mild inflammatory reaction along the presumptive needle track. Lidocaine with epinephrine, however, destroyed most of the muscle in which it was injected. Myonecrosis was qualitatively similar in humans. The rat provides a good model for the study of local anesthetic-induced myonecrosis.

Key Words: ANESTHETICS, Local: lidocaine • MUSCLE, Skeletal: local anesthetic toxicity • TOXICITY: local anesthetic

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999