Does Low-does Cervical Epidural Lidocaine Cause Transient Weakness?

Do Cervical Interlaminar Epidural Steroid Injections With Low-dose Lidocaine Cause Transient Objective Upper Extremity Weakness? A Prospective Randomized

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.

Each subject will be randomized into a group assignment in a 1:1 manner, #1 or #2, as outlined in the Methods section.

Group #1: Interlaminar cervical ESI at the C7-T1 level with triamcinolone acetonide 80 mg (40 mg/mL) + 2 mL 1% lidocaine (total volume 4 mL).

Group #2: Interlaminar cervical ESI at the C7-T1 level with triamcinolone acetonide 80 mg (40 mg/mL) + 2 mL preservative saline (total volume 4 mL).

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 of 40 mg/mL will be used as the steroid in group #1 and group #2 cervical interlaminar procedures.

Pain intensity will be measured by a 0-10 scale called Numerical Rating Scale. (0 being no pain and 10 being worst pain)

Inclusion Criteria: Age 18-80. Clinical diagnosis of cervical radicular pain. Magnetic resonance imaging pathology consistent with clinical symptoms/signs. Numerical Rating Scale (NRS) pain score of 4 or higher. Pain duration of more than 6 weeks despite trial of conservative therapy (medications, physical therapy, or chiropractic care). Patients who will undergo CESI for treatment of cervical radiculitis. Exclusion Criteria: Refusal to participate, provide consent, or provide communication and follow-up information for duration of the study. Inability to perform handgrip or arm strength testing. Contraindications to Cervical ESI (active infection, bleeding disorders, current anticoagulant or antiplatelet medication use, allergy to medications used for CIESI, and pregnancy). Current glucocorticoid use or ESI within past 6 months. Prior cervical spine surgery. Cervical spinal cord lesions; cerebrovascular, demyelinating, or other neuro-muscular muscular disease. Patient request for or requirement of conscious sedation for the injection procedure.

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