Transient heat hyperalgesia during resolution of ropivacaine sciatic nerve block in the rat.

Abstract

Preliminary studies using perineural sciatic ropivacaine in rat demonstrated unexpected heat hyperalgesia after block resolution. To better characterize the time course relative to mechanical anesthesia-analgesia, we tested the hypothesis that ropivacaine 0.5% leads to transient heat hyperalgesia in rats independent of mechanical nociception. We also evaluated functional toxicity (eg, long-term hyperalgesia and/or tactile allodynia 2 weeks after injection). Under surgical exposure, left sciatic nerve block was performed in 2 groups of adult male rats-ropivacaine (200 μL, 5 mg/mL; n = 14) versus vehicle (n = 11). The efficacy and duration of block were assessed with serial heat, mechanical (Randall-Selitto testing), and tactile (von Frey-like monofilaments) tests; motor-proprioceptive (rotating rod) and sedation tests were used at 1 and 7 hrs after injection. The presence of nerve injury was assessed by repeating the heat, tactile, and motor tests 12 to 14 days after injection. Ropivacaine-induced anesthesia was fully manifest at 1 hr after injection. At 3 hrs after injection, heat hypersensitivity was present in the setting of resolved mechanical analgesia. All behavioral measures returned to baseline by 2 weeks after injection. There was no evidence of (i) behavioral sedation, (ii) persistent changes in heat or mechanical sensitivity, or (iii) persistent changes in proprioceptive-motor function at 12 to 14 days after injection. Ropivacaine 0.5% induces transient heat hyperalgesia in the setting of resolved mechanical analgesia, further suggestive of modality and/or nociceptive fiber specificity. Whether this finding partially translates to "rebound pain" after patients' nerve blocks wear off requires further study.