Bupivacaine preferentially blocks ventral root axons in rats

Abstract

Background: Clinically, bupivacaine can provide excellent sensory anesthesia with minimal impairment of motor function. However, the mechanism by which local anesthetics produce differential sensory-motor nerve block is still unknown. The primary site of action for spinal and epidural anesthetics is thought to be the intradural segment of the spinal root. To determine the differential susceptibility of single motor and sensory nerve fibers to local anesthetic conduction block, bupivacaine effects on individual dorsal root (DR) and ventral root (VR) axons were studied. Methods: Lumbar DRs and VRs were excised from anesthetized adult male rats. Single-fiber dissection and recording techniques were used to isolate activity in individual axons. Supramaximal constant-voltage stimuli at 0.3 Hz were delivered to the root. During in vitro perfusion, each root was exposed to increasing concentrations of bupivacaine, and the minimum blocking concentration (C(m)) and the concentration that increased conduction latency by 50% (latency EC50) were measured. Results: Ventral root axons were significantly more sensitive to the steady-state conduction blocking effects of bupivacaine than were either myelinated or unmyelinated DR axons (DR-C((m)) 32.4 μM; VR-C((m)) 13.8 μM; P < 0.0001). In addition, VR axons were more susceptible to the latency- increasing effects of bupivacaine than were DR axons (DR-EC50 = 20.7 μM; VR-EC50 8.5 νM; P < 0.0001). Within axon groups, differential sensitivity as a function of conduction velocity (axon diameter), or length of nerve exposed to the anesthetic could not be demonstrated. Conclusions: In contrast to clinical expectations, low concentration of bupivacaine preferentially block motor (VR) axons in the rat.