Histopathological effects of intramuscular metamizole sodium on rat sciatic nerve

Document Type: Original Article

Authors

1 Bitlis Branch Directorate, Council of Forensic Medicine, The Ministry of Justice, Bitlis, Turkey

2 Department of Histology, Medical Faculty, Recep Tayyip Erdoğan University, Rize, Turkey

3 The Ministry of Justice, Council of Forensic Medicine, Istanbul, Turkey

Abstract

Objective(s): We investigated the histopathological effects of metamizole sodium (MS) on the sciatic nerve. 
Materials and Methods: This study was performed using 48 adult male Wistar albino rats. Ten groups were constituted with 6 rats in each group. MS injection into the sciatic nerve (group 1), MS injection into the muscle [group 3 (50 mg/kg, 0.4 ml) and group 5 (50 mg/kg, 0.8 ml)], MS injection into the muscle cavity in the vicinity of the sciatic nerve [group 2 (50 mg/kg, 0.4 ml) and group 4 (50 mg/kg, 0.8 ml)], normal saline injection into the muscle in the vicinity of the sciatic nerve [group 6A (0.4 ml) and 6B (0.8 ml)], subjected to injury by drilling the entire layer of nerve without injecting any drug, normal saline injection in the sciatic nerve, and control group. Nerve and muscle samples were taken 7 days after administrations. Tissue sections were stained using a hematoxylin and eosin-Luxol® fast blue stain, assessed by a histologist.
Results: The levels of axonal degeneration of the rats in groups 1, 2, 3, 4, 5, 6A, and  8 were found to be significantly higher compared to the levels of the rats in the control group (P<0.05). Myelin degeneration of the rats in all groups was found to be significantly higher compared to myelin degeneration of the rats in the control group (P<0.05).
Conclusion: It was observed that MS could lead to injury in the sciatic nerve with a toxic effect due to diffusion.

Keywords


1. Eker HE, Cok OY, Aribogan A. A treatment option for post-injection sciatic neuropathy: transsacral block with methylprednisolone. Pain Physician 2010; 13:451-456.

2. Gündüz A, Uzun N, Alkan N, Savrun FK, Kızıltan ME. Injection neuropathies of the sciatic nerve: experience of an electrophysiology laboratory and medicolegal approach in Turkey. Arch Neuropsychiatry 2012; 49:208-211.

3. Kaya N, Turan N, Palloş AÖ. Should not the dorsogluteal site be used for intramuscular injection? Florence Nightingale J Nursing 2012; 20:146-153.

4. Nicoll LH, Hesby A. Intramuscular injection: an integrative research review and guideline for evidence-based practice. Appl Nurs Res 2002; 16:149-162.

5. Bağış S,  Adam M,  Leblebici ÜB, Karataş M, Güven AZ, Çeliker AR. Sciatic nerve injury due to intramuscular injection: electrophysiological findings and one-year follow-up. Turk J Med Sci 2012; 42:913-917.

6. Dönertaş B, Alkan A, Mollahaliloğlu S, Seçkin C, Akıcı A. Investigation of paranteral drug use in family health care centers across 32 provinces of Turkey. Anatolian J Clin Invest 2013; 7:31-40.

7. Sağduyu H, Güngör M, Arıcıoğlu F, Uysal V, Koyuncuoğlu H. The effects of co-trimoxazole and dipyrone on renal functions of rats. J ANKEM 1988; 2:326-334.

8. Unal V, Unal EO, Emir A, Ozer Y, Cagdır A. Medicolegal approach to post-injection neuropathy cases.  Bull Leg Med 2015; 20:14-20.

9. Sevim S, Kaleagası H. Sciatic injection injuries in adults: Is dipyrone a foe to nerve? Acta Neurol Belg 2009; 109:210-213.

10. Hobbenaghi R, Javanbakht J, Hosseini E, Mohammadi S, Rajabian M, Moayeri P, et al. Neuropathological and neuroprotective features of vitamin B12 on the dorsal spinal ganglion of rats after the experimental crush of sciatic nerve: an experimental study. Diagn Pathol 2013; 8:123.

11. Kim HJ, Park SH. Sciatic nerve injection injury. J Int Med Res 2014; 42:887–897.

12. Alonge IAO, Akinwola MO. Post-injection sciatic neuropathy: a five-year review of cases managed in a paediatric hospital in Ibadan, Nigeria. Afr J Physiother Rehabil Sci 2010; 2:10-13.

13. Kakati A, Bhat D, Devi BI, Shukla D. Injection nerve palsy. J Neurosci Rural Pract 2013; 4:13-17.

14. Gentili F, Hudson AR, Hunter D. Clinical and experimental aspects of injection injuries of peripheral nerves (Abstract). Can J Sci 1980; 7:143-151.

15. Gentili F, Hudson A, Kline DG, Hunter D. Peripheral nerve injection injury: an experimental study. J Neurosurg 1979; 4:244-253.

16. Mackinnon SE, Hudson A, Gentili F, Kline DG, Hunter D. Peripheral nerve injection injury with steroid agents. Plast Reconstr Surg 1982; 69:482-490.

17. Jeng C, Rosenblatt M. Intraneural injections and regional anesthesia: the known and the unknown. Minerva Anestesiol 2011; 77:54-58.

18. Myers RR, Powel HC, Costello ML. Endoneurial fluid pressure: direct measurement with micro-pipettes. Brain Res 1978; 148:510-515.

19. Whitlock EL, Brenner MJ, Fox IK, Moradzadeh A, Hunter DA, Mackinnon SE. Ropivacaine-induced peripheral nerve injection injury in the rodent model. Anesth Analg 2010; 111:214-220.

20. Gentili F, Hudson A, Kline D, Hunter D. Early changes following injection injury of peripheral nerves. Can J Surg 1980; 23:177-182.

21. Barry JM, Harsh V, Kumar A, Patil S. Injection nerve palsy: What's to blame? J Neurosci Rural Pract 2013; 4:481.

22. Villarejo, Francisco J, Pascual AM. Injection injury of the sciatic nerve (370 cases). Childs Nerv Syst 1993; 9:229-232.