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Clinical and Experimental Aspects of Injection Injuries of Peripheral Nerves

Published online by Cambridge University Press:  18 September 2015

Fred Gentili ,
Alan R. Hudson  and
Daniel Hunter
Fred Gentili
Affiliation:
Division of Neurosurgery, University of Toronto and St. Michael's Hospital, Toronto, Ontario, Canada
Alan R. Hudson*
Affiliation:
Division of Neurosurgery, University of Toronto and St. Michael's Hospital, Toronto, Ontario, Canada
Daniel Hunter
Affiliation:
Division of Neurosurgery, University of Toronto and St. Michael's Hospital, Toronto, Ontario, Canada
*
38 Shuter Street, Toronto, Ontario, Canada M5B 1A6
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Injury to peripheral nerves complicating deep intramuscular injections of antibiotic and other agents is well recognized and can result in significant permanent neurological deficit. The purpose of this paper is to review the subject of nerve injection injuries, and report on a series of recent experimental studies carried out in this laboratory designed to improve our understanding of the pathophysiology of this condition and help provide a rational basis for its treatment. A wide variety of chemotherapeutic, prophylactic, and local anaesthetic agents in common use were injected into the sciatic nerve of the adult Wistar rat. Both intrafascicular and extrafascicular injections were examined. Results revealed that the site of injection was the most crucial factor in determining the degree of nerve fiber injury. Following intrafascicular injection, the degree of injury varied significantly, depending upon the specific agent injected. The most severe injuries were associated with wide-spread axonal and myelin degeneration. Pathological alterations in the nerve were evident as early as 30 minutes following injection injury. Regeneration was a constant finding in nerve damage by injection of the various agents. The mechanism of injury appeared to be a direct toxic effect of the injected compound on neural tissue, with an associated break down of the bloodnerve barrier.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 7 , Issue 2 , May 1980 , pp. 143 - 151
Copyright
Copyright © Canadian Neurological Sciences Federation 1980

References

REFERENCES

Bonica, J.J. (1954). The Management of Pain, 2nd Ed. Lea and Febiger, Philadelphia. 227–228.Google ScholarPubMed
Broadbent, T.R., Odom, G.L, Woodhall, B. (1948). Peripheral Nerve Injuries from Administration of Penicillin, J.A.M.A. 140: 1008–1010.CrossRefGoogle Scholar
Burkel, W.E., McPhee, M.A. (1970). Effect of Phenol injection into Peripheral Nerve of Rat, Arch. Phys. Med. & Rehab. 51: 391–397.Google ScholarPubMed
Chino, N., Awad, E.A., Kottke, F.J.A. (1974). Pathology of Propylne Glycol Administered by Perineurial and Extramus-cular Injection in Rats. Arch. Phys. Med. Rehab. 55: 33–38.Google Scholar
Clark, K., Williams, P.E. Jr., Willis, W., McGravan, W.A. (1970). Injection Injury of the Sciatic Nerve, Clin. Neurosurg. 17: 111–125.CrossRefGoogle ScholarPubMed
Clark, W.K.A. (1972) Surgery for Injection Injuries of Peripheral Nerves. Surg. Clinic of North Amer. 52: 1325–1328.CrossRefGoogle ScholarPubMed
Combes, M.S., Clark, W.K., Gregory, CF., James, J.A. (1960). Sciatic Nerve Injury in Infants: Recognition and Prevention of Impairment Resulting from Intragluteal Injection, J.A.M.A. 173: 1330–1339.CrossRefGoogle Scholar
Combes, M.A. and Clark, W.K.A. (1960). Sciatic Nerve Injury Following Intragluteal Injection: Pathogenesis and Prevention. Amer. J. Dis. Child: 100–579. (abstr.)Google Scholar
Curtis, P.A. Jr., Tucker, H.J.A. (1960). Sciatic Palsy in Premature Infants: A Report and Follow-up Study of 10Cases, J.A.M.A. 174: 1586–1588.CrossRefGoogle Scholar
Gentili, F., Hudson, A.R., Kline, D., Hunter, D. (1979A). Peripheral Nerve Injection Injury. An Experimental Study. Neurosurgery 4: 244–253.CrossRefGoogle ScholarPubMed
Gentili, F., Hudson, A.R., Hunter, D. (1979B). Early Changes following Injection Injury of Peripheral Nerves — A Light E.M. and Fluorescent Microscopic Study, (accepted by Can. Surgery, J. issue of March 1980)Google Scholar
Gentili, F., Hudson, A.R., Hunter, D., Kline, D. (1979C). Nerve Injection Injury with Local Anaesthetic Agents - A Light, Electron Microscopic, Fluorescent Microscopic and Horseradish Peroxidase Study, (accepted by Neurosurgery, issue of March 1980)Google Scholar
Gilles, F.H., French, J.H. (1961). Post-injection Sciatic Nerve Palsies in Infants and Children, Pediat, J. 58: 195–204.Google Scholar
Graham, R.C., Karnovsky, M.J. (1966). The Early Stages of Absorption of Injected Horseradish Peroxidase in the Proximal Tubules of the Mouse Kidney. Ultrastructural Correlates by a New Technique. Histochem, J. Cytochem. 14: 291–302.Google ScholarPubMed
Hanson, D.J.A. (1963). Intramuscular Injection Injuries and Complications, Gen. Pract. 27: 109–115.Google Scholar
Holbrook, T.J., Pilcher, C. (1950). The Effects of Injection of Penicillin. Peanut Oil and Beeswax, Separately and in Combination Upon Nerve and Muscle, Surg. Gyn. Obs. 90: 39–44.Google ScholarPubMed
Hudson, A., Kline, D.G., Gentili, F. (1980). Management of Peripheral Nerve Problems. Ed. George, E.Orner, M.D. and Morton Spinner, M.D., W.B. Saunders Co., Phil., p. 639–653.Google Scholar
Kline, D.G., Hudson, A. (1976). Early Management of Peripheral Nerve Injury. In Current Controversies in Neurosurgery, edited by Morley, T.P. Saunders 181–198.Google Scholar
Kolb, L.C., Gray, S.J. (1946). Peripheral Neuritis as a Complication of Penicillin Therapy J.A.M.A. 132: 323–326.CrossRefGoogle ScholarPubMed
Linden, D.W., Gurdjian, E.S. (1970). Injuries of Nerves. Clinical Aspects in Handbook of Clinical Neurology, Vol. 7, Part 1, Chapter 8: 257–264, North-Holland Publishing Co., Amsterdam.Google Scholar
Ling, CM., Loong, S.C. (1976). Injection of the Radial Nerve Injury 8: 60–62.Google Scholar
Lundborg, Goran (1970). Ischemic Nerve Injury. Experimental Studies on Intraneural Microvascular Pathophysiology and Nerve Function in a Limb Subjected to Temporary Circulatory Arrest. Scandinavian J. Plast Reconstr. Surg. Supplement 6, 1970.Google Scholar
Matson, D.D. (1950). Early Neurolysis in the Treatment of Injury of the Peripheral Nerves Due to Faulty Injection of Antibiotics, New Eng. J. Med. 242: 973–975.CrossRefGoogle ScholarPubMed
Moore, D.C (1955). Complications of Regional Block, Charles C. Thomas, Springfield, Mass. 112–118.Google Scholar
Olsson, Y.A. (1966). Studies on Vascular Permeability in Peripheral Nerves. 1. Distribution of Circulating Fluorescent Serum Albumin in Normal, Crushed and Sectioned Rat Sciatic Nerve, Acta. Neuropathologica 7: 1–15.CrossRefGoogle ScholarPubMed
Olsson, Y., Reese, T. (1971). Permeability of Vasa Nervorum and Perineurium in Mouse Sciatic Nerve Studied by Fluorescence and Electron Microscopy, J. Neuropath. Exp. Neurol. 30: 105.CrossRefGoogle ScholarPubMed
Scheinberg, L., Allensworth, M. (1957). Sciatic Neuropathy in Infants Related to Antibiotic Injections, Pediatrics 19: 261–265.CrossRefGoogle Scholar
Selander, D., Dhuner, K.G., Lundborg, G. (1977). Peripheral Nerve Injury Experimental Study of the Acute Effects of Needle Point Trauma, Acta Anaesth. Scand. 21: 182–188.CrossRefGoogle ScholarPubMed
Selander, D., Brattsand, R., Lundborg, G., Nordborg, C, Olsson, Y. (1979). Local Anaesthetic: Importance of Mode of Application, Con-centration and Adrenalin for the appearance of Nerve Lesions. Acta. Aneslh. Scand. 23: 127–136.CrossRefGoogle Scholar
Steinwall, O., and Klatzo, I. (1966). Selective Vulnerability of the Blood-Brain Barrier in Chemically induced Lesions, J. Neuropath. Exp. Neurol. 25: 542–559.CrossRefGoogle ScholarPubMed
Sun, C.N., White, H.J. (1974). Dysfunction and Remyelination of Peripheral Nerve After Alcohol Injury, Exp. Path. 9: 169–174.Google Scholar
Tarlov, I.M., Perlmutler, I. (1951). Berman, A.N.: Paralysis Caused by Penicillin Injection: Mechanism of Complication — A Warning, J. Neuropath. Exp. Neurol. 10: 158–176.CrossRefGoogle Scholar
Turner, G.G. (1920). The Site for Intramuscular Injections, Lancet 2: 819.CrossRefGoogle Scholar
Von Hochstetter, A. (1955). Problems and Technique of Intragluteal Injections. 1. Influence of Medication and Patient Characteristics on the Development of Syringe Injuries, Schweiz, Med. Wschr. 85: 1138–1144.Google Scholar
Waksman, B.H. (1961). Experimental Stdy of Diptheric Polyneuritis in the Rabbit and Guinea Pig. III The Blood-Nerve Barrier in the Rabbit, J. Neuropath. Exp. Neurol. 20: 35–77.CrossRefGoogle Scholar
Woodall, B., Broadbent, T.R., Ta Ver, J. (1950). The Neuropathology of Antibiotic-induced peripheral nerve paralysis Surg. Forum 1: 394–399.Google Scholar