Does cervical interlaminar epidural steroid injection with low-dose lidocaine cause objective upper extremity weakness? A preliminary study

Zachary L. McCormick*, Ariana Nelson, Mark C. Kendall, Robert J. McCarthy, Geeta Nagpal, David R Walega

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective. Low-dose local anesthetic is often used in cervical interlaminar epidural steroid injections (CIESI), yet its effect on upper extremity strength has not been studied. The presence of consequent weakness has potential implications for postprocedure safety. This study aimed to determine whether low-dose lidocaine in a C7-T1 CIESI causes objective weakness. Design. Prospective case series. Setting. Academic pain center. Subjects. Adults, cervical radicular pain. Methods. Participants underwent CIESI with 1mL of 1% lidocaine (3mL total injectate). Elbow flexion (EF), wrist extension (WE), elbow extension (EE), and handgrip strength were measured by dynamometry at baseline, 15 minutes, and 30 minutes postinjection. Changes in strength from baseline and the proportion of participants with a minimum perceptible change in EF, WE, EE, and handgrip strength (≥20%) and 95% confidence intervals (CIs) were calculated. Results. Twenty-seven participants were included. At 15 and 30 minutes postinjection, there was no within-participant difference in EF, WE, EE, and handgrip strength from baseline overall. Nonetheless, five (19%, 95% CI54-33) of the participants demonstrated a 20% or greater strength decrease in at least one myotomal distribution. A 20% or greater decrease in strength was present in left EF 4% (95% CI50-11%), right EF 7% (95% CI50-17%), left WE 4% (95% CI50-11%), and right WE 7% (95% CI50-17%). Conclusions. The present data suggest that CIESI with an injectate volume of 3mL that includes 1mL of 1% lidocaine may result in objective upper extremity weakness that is above the minimum threshold of perception in a subset of patients.

Original languageEnglish (US)
Pages (from-to)2296-2305
Number of pages10
JournalPain Medicine (United States)
Volume18
Issue number12
DOIs
StatePublished - Dec 1 2017

Fingerprint

Epidural Injections
Elbow
Lidocaine
Upper Extremity
Steroids
Wrist
Pain Clinics
Neck Pain
Local Anesthetics
Confidence Intervals
Safety

Keywords

  • Anesthetics
  • Cervical epidural steroid
  • Injections
  • Lidocaine
  • Local
  • Muscle strength dynamometer
  • Patient safety

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

@article{bb05cc752f2c451daf74a4ac7362ec43,
title = "Does cervical interlaminar epidural steroid injection with low-dose lidocaine cause objective upper extremity weakness? A preliminary study",
abstract = "Objective. Low-dose local anesthetic is often used in cervical interlaminar epidural steroid injections (CIESI), yet its effect on upper extremity strength has not been studied. The presence of consequent weakness has potential implications for postprocedure safety. This study aimed to determine whether low-dose lidocaine in a C7-T1 CIESI causes objective weakness. Design. Prospective case series. Setting. Academic pain center. Subjects. Adults, cervical radicular pain. Methods. Participants underwent CIESI with 1mL of 1{\%} lidocaine (3mL total injectate). Elbow flexion (EF), wrist extension (WE), elbow extension (EE), and handgrip strength were measured by dynamometry at baseline, 15 minutes, and 30 minutes postinjection. Changes in strength from baseline and the proportion of participants with a minimum perceptible change in EF, WE, EE, and handgrip strength (≥20{\%}) and 95{\%} confidence intervals (CIs) were calculated. Results. Twenty-seven participants were included. At 15 and 30 minutes postinjection, there was no within-participant difference in EF, WE, EE, and handgrip strength from baseline overall. Nonetheless, five (19{\%}, 95{\%} CI54-33) of the participants demonstrated a 20{\%} or greater strength decrease in at least one myotomal distribution. A 20{\%} or greater decrease in strength was present in left EF 4{\%} (95{\%} CI50-11{\%}), right EF 7{\%} (95{\%} CI50-17{\%}), left WE 4{\%} (95{\%} CI50-11{\%}), and right WE 7{\%} (95{\%} CI50-17{\%}). Conclusions. The present data suggest that CIESI with an injectate volume of 3mL that includes 1mL of 1{\%} lidocaine may result in objective upper extremity weakness that is above the minimum threshold of perception in a subset of patients.",
keywords = "Anesthetics, Cervical epidural steroid, Injections, Lidocaine, Local, Muscle strength dynamometer, Patient safety",
author = "McCormick, {Zachary L.} and Ariana Nelson and Kendall, {Mark C.} and McCarthy, {Robert J.} and Geeta Nagpal and Walega, {David R}",
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volume = "18",
pages = "2296--2305",
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Does cervical interlaminar epidural steroid injection with low-dose lidocaine cause objective upper extremity weakness? A preliminary study. / McCormick, Zachary L.; Nelson, Ariana; Kendall, Mark C.; McCarthy, Robert J.; Nagpal, Geeta; Walega, David R.

In: Pain Medicine (United States), Vol. 18, No. 12, 01.12.2017, p. 2296-2305.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Does cervical interlaminar epidural steroid injection with low-dose lidocaine cause objective upper extremity weakness? A preliminary study

AU - McCormick, Zachary L.

AU - Nelson, Ariana

AU - Kendall, Mark C.

AU - McCarthy, Robert J.

AU - Nagpal, Geeta

AU - Walega, David R

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Objective. Low-dose local anesthetic is often used in cervical interlaminar epidural steroid injections (CIESI), yet its effect on upper extremity strength has not been studied. The presence of consequent weakness has potential implications for postprocedure safety. This study aimed to determine whether low-dose lidocaine in a C7-T1 CIESI causes objective weakness. Design. Prospective case series. Setting. Academic pain center. Subjects. Adults, cervical radicular pain. Methods. Participants underwent CIESI with 1mL of 1% lidocaine (3mL total injectate). Elbow flexion (EF), wrist extension (WE), elbow extension (EE), and handgrip strength were measured by dynamometry at baseline, 15 minutes, and 30 minutes postinjection. Changes in strength from baseline and the proportion of participants with a minimum perceptible change in EF, WE, EE, and handgrip strength (≥20%) and 95% confidence intervals (CIs) were calculated. Results. Twenty-seven participants were included. At 15 and 30 minutes postinjection, there was no within-participant difference in EF, WE, EE, and handgrip strength from baseline overall. Nonetheless, five (19%, 95% CI54-33) of the participants demonstrated a 20% or greater strength decrease in at least one myotomal distribution. A 20% or greater decrease in strength was present in left EF 4% (95% CI50-11%), right EF 7% (95% CI50-17%), left WE 4% (95% CI50-11%), and right WE 7% (95% CI50-17%). Conclusions. The present data suggest that CIESI with an injectate volume of 3mL that includes 1mL of 1% lidocaine may result in objective upper extremity weakness that is above the minimum threshold of perception in a subset of patients.

AB - Objective. Low-dose local anesthetic is often used in cervical interlaminar epidural steroid injections (CIESI), yet its effect on upper extremity strength has not been studied. The presence of consequent weakness has potential implications for postprocedure safety. This study aimed to determine whether low-dose lidocaine in a C7-T1 CIESI causes objective weakness. Design. Prospective case series. Setting. Academic pain center. Subjects. Adults, cervical radicular pain. Methods. Participants underwent CIESI with 1mL of 1% lidocaine (3mL total injectate). Elbow flexion (EF), wrist extension (WE), elbow extension (EE), and handgrip strength were measured by dynamometry at baseline, 15 minutes, and 30 minutes postinjection. Changes in strength from baseline and the proportion of participants with a minimum perceptible change in EF, WE, EE, and handgrip strength (≥20%) and 95% confidence intervals (CIs) were calculated. Results. Twenty-seven participants were included. At 15 and 30 minutes postinjection, there was no within-participant difference in EF, WE, EE, and handgrip strength from baseline overall. Nonetheless, five (19%, 95% CI54-33) of the participants demonstrated a 20% or greater strength decrease in at least one myotomal distribution. A 20% or greater decrease in strength was present in left EF 4% (95% CI50-11%), right EF 7% (95% CI50-17%), left WE 4% (95% CI50-11%), and right WE 7% (95% CI50-17%). Conclusions. The present data suggest that CIESI with an injectate volume of 3mL that includes 1mL of 1% lidocaine may result in objective upper extremity weakness that is above the minimum threshold of perception in a subset of patients.

KW - Anesthetics

KW - Cervical epidural steroid

KW - Injections

KW - Lidocaine

KW - Local

KW - Muscle strength dynamometer

KW - Patient safety

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DO - 10.1093/pm/pnx037

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JF - Pain Medicine

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