Is polyneuropathy a known adverse effect of sevoflurane, propofol, fentanyl, atracurium, metoclopra

Fråga: Is polyneuropathy a known adverse effect of sevoflurane, propofol, fentanyl, atracurium, metoclopramide, tramadol or ketobemidone? A woman was exposed to the drugs mentioned above during an uneventful gynaecological surgical procedure one year ago. Shortly thereafter, she noticed bilateral numbness of the feet. The symptoms have gradually worsened during the past year and a neurophysiological examination has revealed a progressive axonal sensory denervation.

Sammanfattning: Seven out of 13 volunteers exposed to prolonged sevoflurane anaesthesia developed transient or long-standing neuropathy of the extremities. However, this could be due to nerve compression without relation to sevoflurane itself. There are also sporadic reports of neuropathy in patients treated with the other drugs mentioned, but no causal relationships have been established.

Svar: One report of two healthy young men developing peripheral neuropathy immediately after prolonged anaesthesia with sevoflurane was found. One of the subjects experienced pain in both shoulders and right thigh, with numbness in the latter. The symptoms gradually resolved over several weeks. The other subject experienced numbness and allodynia of the right hand. An electromyogram indicated median nerve compression at elbow level. Surgical decompression at ten months and sympathectomy at twelve months resulted in a substantial improvement. Of an additional 13 healthy volunteers exposed to eight hours of sevoflurane anaesthesia, seven complained of pain and allodynia in the upper or lower extremities, with duration of 2-14 days. The neurological symptoms could be explained by nerve compression secondary to immobilisation, but the reporting authors speculate that sevoflurane could somehow have predisposed the subjects to neuropathy (1).

In Swedis, there are two reports of neuralgia where a causal relationship to propofol has been deemed possible. In one of these cases, propofol had been injected extravasculary causing a local nerve injury (2).

In the WHO database Intdis, neuropathy has been reported in users of all the mentioned drugs except sevoflurane. However the number of reports is small and due to differences in the participating countries´ reporting systems the causal relationship between medication and neuropathy has not been evaluated (3).

No other reports of neuropathy in patients treated with sevoflurane or any of the other mentioned substances were found in Medline, Drugline or standard pharmacological literature.