"Does low-does cervical epidural lidocaine cause transient weakness?"
Cervical radicular pain is relatively common, often treated with epidural steroid injection (ESI), when conservative treatments like oral analgesics, physical therapy, and activity modification have failed. There are no universal clinical practice guidelines for the use of diluents when CESI are performed. Interlaminar CESI may be performed with or without the use of local anesthetics, due to training bias or theoretical concerns of weakness. CESI without the benefit of local anesthetic as a steroid diluent increases the latency of pain relief and may decrease diagnostic information immediately after a CESI with regard to pain generators responsible for symptoms, and may potentially decrease patient satisfaction. By evaluating the effects of local anesthetic as a diluent during interlaminar cervical ESI, we will enhance the safety of this treatment with regard to expectations of objective motor weakness as well as post procedure pain control in the recovery phase after the injection procedure. Additionally, investigation of short-term pain, function, medication use, and global impression of change following use of local anesthetic versus saline as a diluent during interlaminar cervical ESI will provide evidence to inform the optimization of clinical outcomes related to steroid diluent choice.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
16
Interlaminar cervical epidural steroid injection at the C7-T1 level with triamcinolone 80 mg (40 mg/mL) + 2 mL 1% lidocaine.
Interlaminar cervical epidural steroid injection at the C7-T1 level with triamcinolone 80 mg (40 mg/mL) + 2 mL preservative saline
2 mL lidocaine to be used as steroid diluent in group #1 cervical interlaminar procedure.
University of Utah Orthopaedic Center
Salt Lake City, Utah, United States
Changes in Dynamometer Testing Post Procedure With Lidocaine vs Normal Saline.
Strength Testing Dynamometry post procedure with lidocaine vs normal saline.
Time frame: 30 minutes post-procedure
Sensory Exam Testing Post Procedure With Lidocaine vs Normal Saline.
Sensory Exam of upper extremity
Time frame: 30 minutes post-procedure
Mean Arterial Blood Pressure Changes
Mean Arterial Pressure
Time frame: 30 minutes post-procedure
Heart Rate Changes
Heart Rate
Time frame: 30 minutes post-procedure
Pain Intensity
Pain intensity will be measured by a 0-10 scale called Numerical Rating Scale. (0 being no pain and 10 being worst pain)
Time frame: pre procedure, post-procedure, 1 day follow up, and one month follow up
Upper Extremity Functional Index
Upper Extremity Functional Index (UEFI) Questionnaire
Time frame: pre procedure, post-procedure, 1 day follow up, and one month follow up
Pain Medication
Pain medication changes throughout treatment using MQS III calculator
Time frame: pre procedure, post-procedure, 1 day follow up, and one month follow up
Patient Global Impression of Change
7 point question called Patient Global Impression of Change
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
2 mL of 40 mg/mL will be used as the steroid in group #1 and group #2 cervical interlaminar procedures.
2 mL of normal saline to be used as steroid diluent in group #2 cervical interlaminar procedure.
Time frame: one month follow up