Local Anesthetic Myotoxicity: A Case and Review

Bupivacaine crystal deposits after long-term epidural infusion

“…At this point interventional pain therapy, such as epidural analgesia can be introduced with much greater efficacy [12]. Tissue toxicity to LA has been documented in animal studies particularly at higher concentrations [2,3,4,6,7,8,11,13,14,15,16,17,18,19,20,25,29,31,32,33,34,37,38] but seldom observed using the recommended clinical concentrations in humans [1,15,22,23,24,26,28,31].…”

“…It is concluded that the bupivacaine crystalline deposits arose due to precipitation but the clinical significance with regard to sensory level and neuraxial tissue toxicity is unknown. [31] apart from a few case reports [1,15,22,23,24,26,28]. To explain the mechanism of tissue toxicity various pathophysiological pathways of LA or LA mixtures in different human and animal tissues, such as skin, soft tissue, muscle and neurological tissue are discussed but the pathogenesis has not been elucidated in detail [1,13,19,20,29,32,33,34,35,36,37,38].…”

Liposome bupivacaine in peripheral nerve blocks and epidural injections to manage postoperative pain

“…High doses of local anesthetics have the potential to induce myotoxicity and neurotoxicity [2]. Although myotoxicity has been observed in laboratory studies of local anesthetics [35][36][37], clinically relevant myotoxicity appears to be rare [38]. Neuronal toxicity has been reported with all local anesthetics, although relative risk from one to another [39], and it appears to be a function of drug concentration and exposure [40][41][42].…”

Image-Guided Injections of the Hip

“…These injection techniques may be used for therapeutic purposes, functional demonstrations, or even joint aspiration. Ultrasound provides realtime radiographic imaging of the musculoskeletal system and in particular has the ability to make dynamic assessments of deep- [15][16][17]. Chondrotoxicity induced by local anesthetics has come into light recently and care must be taken to avoid this complication.…”