PMID- 32784231
OWN - NLM
STAT- MEDLINE
DCOM- 20210716
LR  - 20220420
IS  - 1532-8651 (Electronic)
IS  - 1098-7339 (Linking)
VI  - 45
IP  - 10
DP  - 2020 Oct
TI  - Effect of low-dose lidocaine on objective upper extremity strength and immediate 
      pain relief following cervical interlaminar epidural injections: a double-blinded 
      randomized controlled trial.
PG  - 767-773
LID - 10.1136/rapm-2020-101598 [doi]
AB  - BACKGROUND: Low-dose lidocaine is a common diluent for analgesia following 
      cervical interlaminar epidural steroid injection (CIESI). Concerns with this 
      practice exist. A single-arm cohort reported that 20% of patients develop 
      postprocedural upper extremity weakness when using lidocaine as a diluent. 
      Furthermore, a high-cervical spinal block with unintended intrathecal or subdural 
      administration is possible. OBJECTIVE: Determine if low-dose lidocaine as a 
      diluent during CIESI causes clinically meaningful (1) upper extremity weakness 
      and (2) immediate pain relief when compared with saline. DESIGN: Double-blinded 
      randomized control trial. METHODS: Patients with cervical radicular pain 
      scheduled for CIESI were enrolled. Participants received lidocaine (CIESI-L) or 
      saline (CIESI-S) as a diluent for the epidural injectate. Myotomal strength was 
      measured with dynamometry before and between 20 and 30 min after CIESI. Pre-pain 
      and post-pain scores were obtained. Primary and secondary outcomes were 
      post-CIESI weakness of >/=20% (minimal clinically important difference (MCID)) in 
      >1 myotome and >/=50% pain reduction on the numerical scale. RESULTS: 120 
      participants (64 females (53%), mean age, 56 (SD 13.7) years) completed the study 
      and were analyzed (CIESI-L n=60; CIESI-S n=60). There was no significant 
      between-group difference in the proportion of participants with postprocedural 
      weakness, CIESI-L 41.7% (95% CI, 29.8% to 54.5%), CIESL-S 50% (95% CI, 37.5% to 
      62.5%). Between-group comparison showed no significant difference in pain 
      reduction, relative risk 1.53 (95% CI, 0.82 to 2.86). CONCLUSION: Low-dose 
      lidocaine as a diluent in CIESI does not significantly increase the risk of 
      post-CIESI myotomal weakness when compared with saline, but also does not 
      substantially increase the likelihood of immediate, meaningful pain relief. TRIAL 
      REGISTRATION DETAILS: ClinicalTrials.gov (NCT03127137); December 26, 2017.
CI  - (c) American Society of Regional Anesthesia & Pain Medicine 2020. No commercial 
      re-use. See rights and permissions. Published by BMJ.
FAU - McCormick, Zachary L
AU  - McCormick ZL
AD  - Division of Physical Medicine and Rehabilitation, Department of Orthopedic 
      Surgery, University of Utah Hospital, Salt Lake City, Utah, USA 
      zmccormi@gmail.com.
FAU - Burnham, Taylor
AU  - Burnham T
AD  - Physical Medicine and Rehabilitation, University of Utah Hospital, Salt Lake 
      City, Utah, USA.
FAU - Cunningham, Shellie
AU  - Cunningham S
AD  - Physical Medicine and Rehabilitation, University of Utah Hospital, Salt Lake 
      City, Utah, USA.
FAU - Kendall, Richard W
AU  - Kendall RW
AD  - Physical Medicine and Rehabilitation, University of Utah Hospital, Salt Lake 
      City, Utah, USA.
FAU - Bougie, David
AU  - Bougie D
AD  - Department of Anesthesiology, Northwestern University, Chicago, Illinois, USA.
FAU - Teramoto, Masaru
AU  - Teramoto M
AD  - Physical Medicine and Rehabilitation, University of Utah Hospital, Salt Lake 
      City, Utah, USA.
FAU - Walega, David R
AU  - Walega DR
AD  - Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, 
      Illinois, USA.
LA  - eng
SI  - ClinicalTrials.gov/NCT03127137
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20200811
PL  - England
TA  - Reg Anesth Pain Med
JT  - Regional anesthesia and pain medicine
JID - 9804508
RN  - 98PI200987 (Lidocaine)
SB  - IM
CIN - Reg Anesth Pain Med. 2021 Dec;46(12):1113. PMID: 33483424
CIN - Reg Anesth Pain Med. 2021 Dec;46(12):1114. PMID: 33483426
MH  - Female
MH  - Humans
MH  - Injections, Epidural
MH  - *Lidocaine/adverse effects
MH  - Middle Aged
MH  - *Pain
MH  - Treatment Outcome
MH  - Upper Extremity
OTO - NOTNLM
OT  - injections, spinal
OT  - neck pain
OT  - outcome assessment, health care
OT  - pain management
OT  - treatment outcome
COIS- Competing interests: ZM and MD serve on the Board of Directors of the Spine 
      Intervention Society.
EDAT- 2020/08/14 06:00
MHDA- 2021/07/17 06:00
CRDT- 2020/08/14 06:00
PHST- 2020/04/27 00:00 [received]
PHST- 2020/06/27 00:00 [revised]
PHST- 2020/07/02 00:00 [accepted]
PHST- 2020/08/14 06:00 [pubmed]
PHST- 2021/07/17 06:00 [medline]
PHST- 2020/08/14 06:00 [entrez]
AID - rapm-2020-101598 [pii]
AID - 10.1136/rapm-2020-101598 [doi]
PST - ppublish
SO  - Reg Anesth Pain Med. 2020 Oct;45(10):767-773. doi: 10.1136/rapm-2020-101598. Epub 
      2020 Aug 11.