Spinal Injections – London Spine Specialists

By Jaimig Aljorna

Spinal injections have the particularity of being both diagnostic and therapeutic. –Diagnostic because it allows discovering the cause of the pain. For instance, when an injection provides pain relief in the area that is injected, then it is the source of the problem. –Therapeutic because it can alleviate temporarily your chronic back pain. Medications In…

Anesthetic and recovery profiles of lidocaine versus mepivacaine for spinal anesthesia in patients undergoing outpatient orthopedic arthroscopic procedures.

By London Spine
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Anesthetic and recovery profiles of lidocaine versus mepivacaine for spinal anesthesia in patients undergoing outpatient orthopedic arthroscopic procedures.

J Clin Anesth. 2012 Mar;24(2):109-15

Authors: Pawlowski J, Orr K, Kim KM, Pappas AL, Sukhani R, Jellish WS

Abstract
STUDY OBJECTIVE: To compare isobaric lidocaine and mepivacaine in outpatient arthroscopic surgery.
DESIGN: Prospective, randomized, double-blinded study.
SETTING: Ambulatory surgery center affiliated with an academic tertiary-care hospital.
PATIENTS: 84 adult, ASA physical status 1, 2, and 3 ambulatory patients, age 18-70 years, undergoing arthroscopic knee surgery.
INTERVENTION: Patients were randomized to receive a combination spinal-epidural anesthetic using 80 mg of either isobaric 2% mepivacaine or isobaric 2% lidocaine. Patients also received a femoral 3-in-1 block with 0.5% bupivacaine applied to the affected extremity.
MEASUREMENTS: Demographic data and level and duration of the block were recorded. The use of supplemental epidural anesthesia was noted along with frequency of bradycardia, hypotension, and episodes of nausea and vomiting. Duration of block and times to ambulation and voiding were recorded. Delayed variables, including fatigue, difficulty urinating, back pain, and transient neurologic symptoms (TNS) were obtained.
MAIN RESULTS: No demographic differences were noted between groups, and surgical duration was similar. Satisfactory anesthesia was achieved in all cases, with no differences noted in hypotension, bradycardia, nausea, or vomiting. Onset of sensory and motor block was similar. Duration of block before epidural supplementation was 94 ± 21 minutes with lidocaine versus 122 ± 23 minutes for mepivacaine (P < 0.011). Times to ambulation and voiding were longer in patients receiving mepivacaine but did not affect PACU stay. Twenty-four and 48-hour recovery was similar with no TNS symptoms reported.
CONCLUSION: No major differences were noted between lidocaine and mepivacaine spinal anesthesia. Time to ambulation and voiding were longer in patients who received mepivacaine as was time to first dose of epidural catheter. Neither group had TNS symptoms. Lidocaine and mepivacaine are both appropriate spinal anesthetics for ambulatory orthopedic lower extremity procedures.

PMID: 22342508 [PubMed – indexed for MEDLINE]

Judging pain sensitivity with subcutaneous lidocaine injections.

By London Spine
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Judging pain sensitivity with subcutaneous lidocaine injections.

Pain Med. 2011 Apr;12(4):668-72

Authors: Manabat ER, Pujol LA, Hunt P, Wang D

Abstract
OBJECTIVE: Pain perception is affected by psychological, social, medical, and environmental conditions, and contributes to the patient’s treatment satisfaction and response. Better understanding of pain perception will likely improve pain assessment and treatment selection. The objective of this study was to define a range of verbal and nonverbal pain responses to a clinical stimulus in a clinical population.
DESIGN: Subjects were 165 patients with chronic pain conditions. The patients were scheduled for elective interventional pain procedures on the lumbar spine including lumbar interlaminar epidural steroid injections, lumbar transforaminal steroid injections, lumbar facet injections, lumbar medial branch nerve blocks, radiofrequency ablation of lumbar medial branch nerves, and lumbar discography. Intervention.  Prior to the procedure, subjects rated anxiety on a numerical rating scale (NRS) from 0 (no anxiety) to 3 (extreme anxiety), and received standardized subcutaneous injections of lidocaine (using 25-G needle to infiltrate 2 cc 1% lidocaine) as local anesthesia. Following the lidocaine injection, pain was rated on an NRS scale. Body movement detected during the injection was rated by an independent observer and recorded as none, less than 1 in., and more than 1 in. Body movement was defined as torso moving away from original prone position.
RESULTS: Patients were 37% men and 63% women, with average age of 53 years. The range of pain intensity responses fell within a normal curve (P < 0.01), with average pain intensity of 4.9 (standard deviation = 2.7). Patients with more body movement reported higher pain (P < 0.01). Anxiety predicted pain intensity ratings (P < 0.01). Use of opioids did not predict pain intensity, body movement, or anxiety.
CONCLUSION: This study shows normal distribution of verbal pain response to a clinical pain stimulus in a clinical population. Body movement and anxiety correlated with verbal pain intensity ratings. Subcutaneous injections of lidocaine may be a useful model for exploration of pain sensitivity in a clinical population.

PMID: 21496198 [PubMed – indexed for MEDLINE]