Toxic effects of epidural analgesia with ropivacaine 0.2% in a diabetic patient

Al-Nasser, Bassam

doi:10.1016/j.jclinane.2003.07.012

Cited by 28 publications

(11 citation statements)

References 19 publications

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“…A case report of a diabetic patient experiencing a persistent lower-extremity neuropathy after what appeared to be an uneventful epidural analgesia reinforces concerns that diabetic patients may be at an increased risk of neurologic injury after neuraxial anesthesia. 48 A retrospective review also evaluated neurologic complications in patients with preexisting peripheral sensorimotor neuropathy or DPN who subsequently underwent neuraxial anesthesia or analgesia. 22 Of the 567 patients studied, 2 (0.4%; 95% confidence interval [CI], 0.1%-1.3%) experienced new or progressive postoperative neurologic deficits when compared with preoperative findings.…”

Section: Diabetic Polyneuropathymentioning

confidence: 99%

Regional Anesthesia in Patients With Preexisting Neurologic Disease

Kopp

Jacob

Hebl

2015

Regional Anesthesia and Pain Medicine

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Since publication of initial recommendations in 2008, there is limited new information regarding the performance of regional anesthesia in patients with preexisting neurologic diseases. However, the strength of evidence has increased since 2008 regarding (1) the concern that diabetic nerves are more sensitive to local anesthetics and perhaps more susceptible to injury and (2) the concern that performing neuraxial anesthesia and analgesia in patients with preexisting spinal canal pathology may increase the risk of new or worsening neurologic symptoms. This increased evidence reinforces our initial recommendations. In addition, since the initial recommendations in 2008, the concept of postsurgical inflammatory neuropathy has been described and is potentially a contributor to postoperative neurologic dysfunction.

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Section: Diabetic Polyneuropathymentioning

confidence: 99%

Regional Anesthesia in Patients With Preexisting Neurologic Disease

Kopp

Jacob

Hebl

2015

Regional Anesthesia and Pain Medicine

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“…Several individual case reports have suggested these complications, rendering the use of epidural analgesia controversial in patients with some peripheral neurological disorders. Newly developed neurological complications after epidural analgesia were reported in a patient with diabetes mellitus [15]. The patient complained of a violent bilateral burning sensation and pain in the back and thighs within 8 hours of discontinuation of epidural analgesia, which persisted for more than 6 days.…”

Section: Discussionmentioning

confidence: 97%

Severe back pain following epidural analgesia in patients with spinocerebellar ataxia: a report of two cases

Iida

Kato

Ogawa

2011

Journal of Clinical Anesthesia

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“…Studies have demonstrated that high and even clinical concentrations of local anesthetics can induce neurotoxicity (1,2). In 1,416 non-diabetic patients receiving a peripheral nerve block in France between Jan 1, 2000 and Dec 31, 2000, the incidence rate of neurological complications was 0.21%, with symptoms including hyperalgesia, dysesthesia and motor dysfunction (3).…”

Section: Introductionmentioning

confidence: 99%

High glucose and bupivacaine‑induced cytotoxicity is mediated by enhanced apoptosis and impaired autophagy via the PERK‑ATF4‑CHOP and IRE1‑TRAF2 signaling pathways

Liu

Sun

et al. 2019

Mol Med Report

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Bupivacaine has previously been reported to induce neurotoxicity, which is further enhanced by high glucose levels. In the present study, the underlying molecular mechanisms via which bupivacaine induces cytotoxicity under high glucose conditions were investigated in cultured human SH-SY5Y cells. In order to identify the optimal concentrations of glucose and bupivacaine that induced cytotoxicity, SH-SY5Y cells were treated with 30–100 mM glucose and 0.5–1.0 mM bupivacaine. Based on the dose response experiments, 50 mM glucose and 0.5 mM bupivacaine was used in the present study. The effects that 3-MA (autophagy inhibitor) and rapamycin (RAPA; autophagy inducer) exerted on cell apoptosis, autophagy and the expression of protein kinase R-like endoplasmic reticulum kinase (PERK)-activating transcription factor 4 (ATF4)-C/EBP-homologous protein (CHOP) and inositol-requiring enzyme 1 (IRE1)-tumor necrosis factor receptor associated factor 2 (TRAF2) signaling proteins were measured in high glucose and bupivacaine-treated cells. Cell viability was measured using a Cell Counting Kit-8 assay, cell apoptosis was assessed using flow cytometry, and protein expression was determined using western blot analyses. Compared with the control group, high glucose and bupivacaine significantly increased ATF4, CHOP and caspase-12 expression, increased apoptosis, and decreased p-IRE1, TRAF2, LC3-II/LC3-I and Beclin1 expression. Promoting autophagy with RAPA partly reversed the high glucose and bupivacaine-induced changes in p-PERK, CHOP, TRAF2, Beclin1, caspase-12 and apoptosis, while inhibiting autophagy with 3-MA further enhanced the changes in ATF4, CHOP, p-IRE1, TRAF2 and apoptosis. High glucose and bupivacaine induced cytotoxicity in SH-SY5Y cells, at least in part, through enhancing cell apoptosis and inhibiting autophagy via the PERK-ATF4-CHOP and IRE1-TRAF2 signaling pathways.

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Toxic effects of epidural analgesia with ropivacaine 0.2% in a diabetic patient

Cited by 28 publications

References 19 publications

Regional Anesthesia in Patients With Preexisting Neurologic Disease

Regional Anesthesia in Patients With Preexisting Neurologic Disease

Severe back pain following epidural analgesia in patients with spinocerebellar ataxia: a report of two cases

High glucose and bupivacaine‑induced cytotoxicity is mediated by enhanced apoptosis and impaired autophagy via the PERK‑ATF4‑CHOP and IRE1‑TRAF2 signaling pathways

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