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In Zucker Diabetic Fatty Rats, Subclinical Diabetic Neuropathy Increases In Vivo Lidocaine Block Duration But Not In Vitro Neurotoxicity
  1. Philipp Lirk, MD, MSc*,,
  2. Magdalena Flatz, MD,
  3. Ingrid Haller, MD,
  4. Barbara Hausott, PhD,
  5. Stephan Blumenthal, MD§,
  6. Markus F. Stevens, MD*,
  7. Suzuko Suzuki, MD,
  8. Lars Klimaschewski, MD and
  9. Peter Gerner, MD,
  1. From the *Department of Anesthesiology, Academic Medical Center, University of Amsterdam, the Netherlands; and
  2. Department of Anesthesiology and Critical Care Medicine and
  3. Division of Neuroanatomy, Innsbruck Medical University, Innsbruck, Austria;
  4. §Department of Anesthesia, Hospital Triemli, Zurich, Switzerland;
  5. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital/Harvard Medical School, Boston, Massachusetts; and
  6. Department of Anesthesiology, Perioperative and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
  1. Address correspondence to: Philipp Lirk, MD, MSc, Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands (e-mail: p.lirk{at}


Background and Objectives Application of local anesthetics may lead to nerve damage. Increasing evidence suggests that risk of neurotoxicity is higher in patients with diabetic peripheral neuropathy. In addition, block duration may be prolonged in neuropathy. We sought to investigate neurotoxicity in vitro and block duration in vivo in a genetic animal model of diabetes mellitus type 2.

Methods In the first experiments, neurons harvested from control Zucker diabetic fatty (ZDF) rats were exposed to acute (24 hours) or chronic (72 hours) hyperglycemia, followed by incubation with lidocaine 40 mM (approximately 1%). In a second experiment, neurons harvested from control ZDF rats, or diabetic ZDF rats, were incubated with lidocaine, with or without SB203580, an inhibitor of the p38 mitogen-activated protein kinase. Finally, we performed sciatic nerve block (lidocaine 2%, 0.2 mL) in control or diabetic ZDF rats and measured motor and nociceptive block duration.

Results In vitro, neither acute nor chronic hyperglycemia altered neurotoxic properties of lidocaine. In vitro, incubation of neurons with lidocaine resulted in a slightly decreased survival ratio when neurons were harvested from diabetic (57% ± 19%) as compared with control (64% ± 9%) rats. The addition of SB203580 partly reversed this enhanced neurotoxic effect and raised survival to 71% ± 12% in diabetic neurons and 66% ± 9% in control rats, respectively. In vivo, even though no difference was detected at baseline testing, motor block was significantly prolonged in diabetic as compared with control rats (137 ± 16 vs 86 ± 17 min).

Conclusions In vitro, local anesthetic neurotoxicity was more pronounced on neurons from diabetic animals, but the survival difference was small. In vivo, subclinical neuropathy leads to substantial prolongation of block duration. We conclude that early diabetic neuropathy increases block duration, whereas the observed increase in toxicity was small.

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  • The authors declare no conflict of interest.

  • This study was supported by departmental funds and the National Institutes of Health, Bethesda, MD (research grant no. GM64051 to P.G.).