Background and objectives Pregnant patients need less local anesthetic in order to obtain the same quality of functional block as nonpregnant patients. Our goal was to demonstrate a similarly increased functional susceptibility to local anesthetics in the awake pregnant rat during peripheral nerve block and to investigate the pharmacokinetic and/or pharmacodynamic mechanisms responsible for this phenomenon.
Methods Radiolabeled lidocaine uptake was determined in vivo during sciatic nerve block with 0.1ml of 1% lidocaine in the nerves of nine pregnant and five nonpregnant female rats and six male rats at the return of deep pain sensation, assessed by withdrawal of the hindlimb from a brief squeeze of a digit with serrated forceps. During recovery from complete functional block, the time at which deep pain returned and the amount of lidocaine in the nerve at that time were compared among the three groups of rats. Lidocaine content was also determined in vitro after exposure of ensheathed sciatic nerves from pregnant and nonpregnant rats to a 0.2% lidocaine bath for specified times.
Results Full block of function developed in all groups within 6 minutes of the lidocaine injection and lasted significantly longer in pregnant rats than in nonpregnant and male rats (49.0 ± 3.3 vs 34.0 ± 3.1 and 32.0 ± 1.3 minutes mean ± SEMI, respectively. At the time of deep pain return, the intraneural lidocaine content of pregnant rats was significantly lower than that of nonpregnant and male rats (2.2 ± 0.25 vs 3.9 ± 0.7 and 3.7 ± 0.6 nmoles/mg of wet nerve, respectively). No difference in lidocaine uptake kinetics between P and NP nerves was observed in vitro.
Conclusions Block of peripheral neural function is prolonged in pregnant rats, and lidocaine content in the nerve is lower at a specific stage of neural block. These results are consistent with a pharmacodynamic mechanism for increased susceptibility to lidocaine neural block during pregnancy.
- lidocaine uptake
- local anesthetics
- sciatic nerve
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Presented in preliminary form at the 1994 Annual Meeting of the American Society of Regional Anesthesia.
Supported in part by the American Society of Regional Anesthesia-Wyeth-Ayerst Young Investigator Award (to F.P-B.) and by a grant from the USPHS (GM35647, to G.R.S.).