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The effect of Marcaine epidural anaesthesia on the spinal cord injured dog
THE EFFECT OF MARCAINE EPIDURAL ANAESTHESIA ON THE SPINAL CORD INJURED DOG
ON THE SPINAL CORD INJURED DOG 0
By S. M. REZAIAN 0
F.R.CS. 0
R. SHAMS 0
0 Department of Scoliosis and Surgery of Spine, Sina Iio$.'pital, University of Tehran , Tehran , Iran
An attempt by using Marcaine epidural anaesthesia has been made to prevent the central cord necrosis of the spinal cord injured dog. Details of the technique and the results are described. IN a previous experimental work the reserpine, a sympathetic blockage has been successfully used to reduce or prevent the release of catecholamine which its peak up is coincident with the central haemorrhagic cord necrosis in rats (Rezaian et at., 1977). But the resperine for the obvious reason that neither could have clinical indication on the management human spinal cord injury, nor was tolerated by dogs for further investigation. Looking for a suitable drug, Marcaine proved to fulfilmost of our aims. Hirst and Wood (1971) suggested that procaine diminished the release of acetylcholine by the nerve motor ending. Similarly when procaine is added to the fluid perfusing a ganglion, preganglion fibre stimulation fails to elicit postganglionic discharges and the ganglion cells become insensitive to stimulation by acetylcholine. Furthermore the production of acetylcholine in response to preganglionic stimulation is diminished, showing that procaine has a marked effect on synaptic ending of the preganglionic fibres as well as on the ganglion cells (Murdoch et at., 1970). Marcaine has all pharmacological effectof procaine plus twice prolonged action. For these reasons we have used Marcaine epidurally to prevent the secondary sympathetical reaction of postspinal cord injury in dogs.
Marcaine
-
Introduction
kiloweight which injected through the main tube of Foley catheter in epidural
space, just before it was to be removed. Dogs in group b were kept for control.
Both groups were in similar cages, fed with milk and commercial food. There
were 22 dogs in group a and 26 in group b.
Observations
(a) Mortalities. Eight dogs died from group b in the first 24 hours and eight
in the subsequent 7 days, due to the spinal cord shock; in a bizarre incontinence
paraplegic condition. Whereas in group a only two dogs died-one immediately
and one 6 hours after the operation. The remaining dogs had uneventful recovery.
(b) Mobilities. Of the ten dogs remaining in group b all were paralysed with
incontinence of urine and faeces. Their general condition gradually deteriorated
in 10-15days and had to be sacrificed before they died. Only four of them
could be kept beyond 3 weeks. On the other hand in group a all 20 dogs had
far better recovery.
Their neurological deficitall improved. Twelve of them were back to normal.
Seven of them could use their hind limbs incompletely, but all of them were alive
over 3 months in paraparesis condition, only one had urine and faeces incon?
tinence.
(c) Histological Section. Immediately postoperative section of both groups
showed equal traumatised reaction with congestion, haemorrhage and oedema of
the cord, extending 10-15mm x 6-8mm. By the end of the first week central
necrosis of the cord was obvious in group b but rare area of necrosis could be seen
in group a (Figs I and 2). At the end of the third week extensive necrosis was
complete in group b, whereas some fibrous reaction could be seen in group a
(Fig. 3).
Dog's cord sections 3 weeks post-injury without treatment.
Discussion and Conclusion
A few drugs have recently been successfully used on treatment of spinal cord
injured animals. Those included 3 -2 bimethyltyrosin (Osterholm et at., 1973),
Alphamethyltyrosin (Yeo et at., 1975) and Reserpin
(Rezaian et at., 1977)
. Un?
fortunately these drugs are not suitable for treatment of human spinal cord injury.
Whereas in the present experimental work we have used Marcaine-a long-acting
local anaesthetic drug which abolishes or diminishes the secondary effect of
catacholamine release which is coincidence with the central haemorrhagic necrosis
of the cord in dog. This drug probably could be safely used in management of
human spinal cord injury.
Dogs were paralysed by a simple quantitative pressure technique. A group
of them were treated with 0?5 ml of 0?5 per cent of Marcaine epidurally. And a
second group were kept untreated for the control. Mortalities in treated group
were very much less than the control one. At the same time recovery of neuro?
logical deficit were remarkable. Histological section proved the fact.
Summary
RESUME
La technique simple a ete employee pour 2 groupes de chiens a et b. Qui a provoqee
une paralysie incomplete Ie groupe 'a' reu;< une dose de 5 ml d une solution de 0" 5 per cent
de marcaine-Iegroupe 'b' a ete garde comme temion.
La mortalite a ete beaucoup moins et la recuperation neurologique en meme temps
a ete mieux dans Ie groupe 'a' que Ie groupe 'b'.
La section histologique egalement approuvee la difference.
ZUSAMMENF (...truncated)