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Intrathecal bupivacaine protects against extension of lesions in an acute photochemical spinal cord injury model

[L’administration intrathécale de bupivacaïne empêche l’extension des lésions chez un modèle photochimique de lésion médullaire]

Sandrine Lopez, MD^*, Alain Privat, MD PhD, Nathalie Bernard, MD^*, Freddy Ohanna, MD PhD, Christine Vergnes, MD and Xavier Capdevila, MD PhD^*

^* From the Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital;
The Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 336, Université Montpellier II;
The Centre Propara; and
The DIM - Hôpital Arnaud de Villeneuve - C.H.U., Montpellier, France.

Address correspondence to: Dr. Xavier Capdevila, Département d’Anesthésie Réanimation A - Hôpital Lapeyronie, 371, Av du Doyen G Giraud, 34295 Montpellier Cedex 5, France. Phone: 00 33 46 733 8256; Fax: 00 33 46 733 7960; E-mail: x-capdevila{at}chu-montpellier.fr

Purpose: The photochemical spinal-cord injury model reproduces extensive secondary lesions that occur after spinal injury. We have evaluated in 27 rats the functional, electrophysiological and anatomical consequences of a photochemical spinal-cord lesion induced before or after intrathecal injection of bupivacaine.

Methods: After randomization, nine rats received 20 µL of intrathecal bupivacaine 0.5% 15 min before a photochemical spinal-cord lesion (Group I) and eight rats received 20 µL intrathecal bupivacaine 15 min after such a lesion (Group II). Ten rats received 20 µL of saline 15 min before the photochemical injury (control group).

Paraplegia was tested on days one, three, five, seven, nine, 12, 15 and 18 using an evaluation of hindlimb movements and an inclined plane stability test. Sensory block was evaluated by the animal’s response when each hindlimb was brought into contact with a hot plate. Sympathetic injury was evaluated in terms of bladder voiding dysfunction. On day 18, residual somatosensory evoked potentials (SEP) were measured and the area of the intact spinal cord was determined using a digitalized system.

Results: Early paraplegia recovery was found in the two bupivacaine groups (P < 0.05). On day 12, motor recovery was complete in both bupivacaine groups whereas recovery was not complete on day 18 in the control group. Compared to the control group, inclined plane stability recovered earlier in Groups I and II, from day three to day 15. Sensory and sympathetic block scores were not different in the three groups. Nevertheless, SEP latencies were longer and amplitudes were lower in control group rats compared with the two bupivacaine groups on day 18. The intact spinal-cord cross-sectional area around the lesion was not different in the three groups.

Conclusion: Twenty microlitres of intrathecal bupivacaine before or after acute photochemical spinal injury improves hindlimb motor recovery and SEP parameters in rats.