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Intrathecal mepivacaine and prilocaine are less neurotoxic than lidocaine in a rat intrathecal model
  1. Tamie Takenami, M.D.,
  2. Saburo Yagishita, M.D.,
  3. Yoshihiro Nara and
  4. Sumio Hoka, M.D.
  1. From the Department of Anesthesiology, Kitasato University School of Medicine (T.T., Y.N., S.H.), Kanagawa, Japan
  2. Department of Pathology, Kanagawa Rehabilitation Center (S.Y.), Kanagawa, Japan
  1. Reprint requests: Tamie Takenami, M.D., Department of Anesthesiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 228-8555, Japan. E-mail: takenami{at}


Background and objectives 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 μL/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 ≥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.

Conclusion It is suggested that intrathecal mepivacaine and prilocaine are less neurotoxic than highly concentrated lidocaine in a rat intrathecal model.

  • Local anesthetics
  • Neurotoxicity
  • Pathology
  • Sensory impairment.

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  • Supported by Grant-in-Aid for Scientific Research (C)(2) 13671611 and (B)(2) 14370494, Ministry of Education, Science, Sports and Culture, Japan.

    Presented in part at the Annual Meeting of the American Society of Anesthesiologists, Dallas, TX, October 17-21, 1999, and the American Society of Regional Anesthesia Pain and Medicine, Vancouver, Canada, May 10-13, 2000.