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

Zachary L. McCormick, Taylor Burnham, Shellie Cunningham, Richard W. Kendall, David Bougie, Masaru Teramoto, David R. Walega

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)767-773
Number of pages7
JournalRegional anesthesia and pain medicine
Volume45
Issue number10
DOIs
StatePublished - Oct 1 2020

Keywords

  • injections, spinal
  • neck pain
  • outcome assessment, health care
  • pain management
  • treatment outcome

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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