Intra-articular Lidocaine Research Articles

Bilateral intra-articular injection of CNTX-4975 for management of painful osteoarthritis of the knee: results at 6 weeks from an open-label trial

Purpose: A prior double-blind, randomized, placebo-controlled trial with a single 1 mg intra-articular injection of CNTX-4975 (highly purified trans-capsaicin) into one knee for management of moderate to severe pain associated with osteoarthritis of the knee revealed a statistically significant decrease in pain with walking vs placebo through 24 weeks post-dose. The present study evaluated cooling parameters to mitigate procedure pain from a single intra-articular injection of CNTX-4975 1 mg into the osteoarthritic knee, and the efficacy and safety of a water-soluble, ready-to-use formulation of CNTX-4975 in a prefilled syringe. Here we present the efficacy and safety outcomes determined 6 weeks after bilateral osteoarthritic knee injections. Methods: Subjects with bilateral moderate to severe painful knee osteoarthritis for ≥3 months prior to study entry consented to receive a single intra-articular injection of CNTX-4975 1 mg into each knee (left knee followed by the right), with 7 days (±2 days) between intra-articular injections. Intra-articular lidocaine 2% (without epinephrine, 15 mL) was given 3-30 minutes before injection of CNTX-4975. Before the injection of lidocaine and throughout the procedure, the skin around the knee was cooled using different techniques. Temperature changes in the knee joint were documented with an intra-articular temperature probe. Pain with walking over the past 24 hours was rated on a Numeric Pain Rating Scale (NPRS, 0-10) at baseline (4-9 inclusive required for enrollment) and at 6 weeks for each knee. Subjects also rated the change in pain in each knee using the Patient Global Impression of Change (PGIC) scale (7-point scale from very much improved to very much worse). Knees were examined to determine the presence of injection site issues, and adverse events were recorded. Results: Fifteen subjects with bilateral knee osteoarthritis, 12 male and 3 female, were enrolled; mean age was 57 years (range, 47-71). There were no discontinuations and no missing data in the outcome measures. As shown in the Table, the baseline and 42-day post-injection NPRS pain scores were averaged across both knees and ranged from 4 to 8. The mean pain with walking score decreased from a baseline value of 6.0 to 1.5 at day 42, for a 75% reduction in pain overall (P<0.00001, two-tailed, paired t-test). Of the 15 subjects, 10 reported a pain level of 2 or less, and 6 subjects reported no pain in either knee 6 weeks post intra-articular injection. A similar pattern of improvement was evident with the PGIC: in 26 of 30 recordings (15 subjects, both knees), subjects described pain at 6 weeks post injection as much improved or very much improved. No subject reported pain as being unchanged or worse in either knee. One subject developed a large ecchymosis at the site of insertion of the intra-articular temperature probe that was deemed related to insertion of the temperature probe. Treatment-emergent adverse events (TEAEs) reported on the day of injection were nausea (n=3), headache (n=2), vasovagal attack, dizziness, elevated blood pressure, and tachycardia (n=1 each); all were reported to be mild and 2 (vasovagal attack and 1 report of nausea) were deemed possibly related to treatment. TEAEs reported after the day of injection were insect bite (n=2) and hay fever, vasovagal attack, back pain, acid reflux (esophageal), allergic conjunctivitis, and bruise (n=1 each); all were mild and deemed unlikely or not related to study treatment. Conclusions: Pain reduction in this open-label trial following bilateral injection of CNTX-4975 1 mg into painful osteoarthritic knees was statistically significant and similar to the pain reduction reported in a prior double-blind, randomized, controlled trial involving injection into one painful osteoarthritic knee (TRIUMPH study). These data support the continued development of intra-articular CNTX-4975 1 mg as a therapy to manage moderate to severe pain associated with knee osteoarthritis.

Use of Ultrasound for Joint Dislocation Reduction in an Austere Wilderness Setting: A Case Report

Point-of-care ultrasound has been shown to have a demonstrable impact in the austere/out-of-hospital environment. As ultrasounds become more affordable and portable, a myriad of uses in austere environments are becoming recognized. We present a case of a stranded hiker with an ultrasound-confirmed glenohumeral joint dislocation who underwent ultrasound-guided intra-articular lidocaine injection and ultrasound-confirmed reduction. This procedure allowed the patient to hike out under his own power, avoiding the potential dangers of extrication to both patient and rescuers. We believe this case demonstrates the feasibility and utility of ultrasound in the out-of-hospital environment both procedurally and diagnostically.

Protective effects of platelet-rich plasma against lidocaine cytotoxicity on canine articular chondrocytes

BackgroundLidocaine (LD) is one of the most commonly used local anesthetics for performing arthroscopic surgery and managing of osteoarthritic pain in both human and veterinary medicine. However, over the last years, several studies have focused on the chondrotoxic effects of LD. In order to ensure that intra-articular lidocaine is safe to use, treatments aimed at mitigating chondrocyte death have recently been investigated. The aim of this study is to evaluate the possible protective effects of platelet-rich plasma (PRP) against LD cytotoxicity on canine articular chondrocytes.ResultsArticular canine chondrocytes, were exposed to 1% or 1.8% LD alone or in co-presence with 10% PRP for 30 min. In order to evaluate the effects of PRP pre-treatments, experiments were carried out on cells cultured in serum-free medium-or in medium supplemented with 10% PRP or 10% fetal bovine serum. Cell viability was evaluated by methyl thiazolyl tetrazolium assay and cell apoptosis was analyzed by flow cytometry using annexin V-fluorescein isothiocyanate/propidium iodide. The results showed that LD significantly reduced canine chondrocytes viability, probably due to apoptosis induction. Pre-treatment or the co-presence of PRP in the media restored the number of viable chondrocytes. The PRP also seemed to protect the cells from LD-induced apoptosis.ConclusionsPre-treatments and/or the simultaneous administration of PRP reduced LD-induced cytotoxicity in canine chondrocytes. Further in vivo studies are required to determine whether PRP can be used as a save protective treatment for dogs receiving intra-articular LD injections.

Platelet-Rich Plasma versus Corticosteroid Intra-Articular Injections for the Treatment of Trapeziometacarpal Arthritis: A Prospective Randomized Controlled Clinical Trial.

Various systematic reviews have recently shown that intra-articular platelet-rich plasma (IA-PRP) can lead to symptomatic relief of knee osteoarthritis for up to 12 months. There exist limited data on its use in small joints, such as the trapeziometacarpal joint (TMJ) or carpometacarpal joint (CMCJ) of the thumb. A prospective, randomized, blind, controlled, clinical trial of 33 patients with clinical and radiographic osteoarthritis of the TMJ (grades: I-III according to the Eaton and Littler classification) was conducted. Group A patients (16 patients) received 2 ultrasound-guided IA-PRP injections, while group B patients (17 patients) received 2 ultrasound-guided intra-articular methylprednisolone and lidocaine injections at a 2-week interval. Patients were evaluated prior to and at 3 and 12 months after the second injection using the visual analogue scale (VAS) 100/100, shortened Disabilities of the Arm, Shoulder, and Hand Questionnaire (Q-DASH), and patient's subjective satisfaction. No significant differences between the baseline clinical and demographic characteristics of the 2 groups were identified. After 12 months' follow-up, the IA-PRP treatment has yielded significantly better results in comparison with the corticosteroids, in terms of VAS score (P = 0.015), Q-DASH score (P = 0.025), and patients' satisfaction (P = 0.002). Corticosteroids offer short-term relief of symptoms, but IA-PRP might achieve a lasting effect of up to 12 months in the treatment of early to moderate symptomatic TMJ arthritis.

Current Approach to the Diagnosis and Management of Shoulder Dislocation in Children.

Shoulder dislocations are a common presentation to the emergency department. Although many cases may be diagnosed by history and clinical examination alone, imaging may help diagnose more challenging cases. Three-view radiographs are important for identifying subtle posterior dislocations, and ultrasonography has been gaining evidence as an alternate diagnostic modality. Intra-articular lidocaine and nerve blocks may improve pain control and reduce the need for procedural sedation. Multiple, evidence-based reduction techniques are described including tips for improving success. Immobilization strategies and follow-up are also discussed.

Is intra-articular lidocaine injection a safe and effective alternative to intravenous analgesia and sedation for the manual reduction of acute anterior shoulder dislocation?

EVIDENCE-BASED ANSWER Yes. Intra-articular lidocaine has a lower risk of complications (especially hypoxia and apnea) and similar reduction success rates and pain relief with shorter length of stay than intravenous (IV) analgesia with sedation in the closed manual reduction of acute anterior shoulder dislocation in adults (SOR: B, meta-analyses of lower quality RCTs and single RCT).

Nerve Block vs. Sedation for Reduction of Anterior Shoulder Dislocation

For reduction of anterior shoulder dislocations, options include procedural sedation, intraarticular lidocaine injection, nerve block, and manipulation

The efficacy of intra-articular lidocaine administration in chronic knee pain due to osteoarthritis: A randomized, double-blind, controlled study

BackgroundIntra-articular injections for the treatment of knee pain due to osteoarthritis are performed when conservative therapies have failed. The intra-articular injection of lidocaine may be an effective treatment modality due to its neuronal membrane-stabilizing effect and long-lasting anti-inflammatory action. In this study, we compared the efficacy of intra-articular 0.5% lidocaine versus saline injection on pain, stiffness and physical function in patients with osteoarthritis. MethodsPatients with osteoarthritis were randomly allocated to two groups. Group I (n=26) received 7mL 0.5% lidocaine and group II (n=26) received 7mL saline into the painful knee for a series of three injections spaced by 1 week intervals under ultrasound guidance. Knee pain was measured with a numeric rating score (NRS) at baseline and 3 months after the 3rd injection. WOMAC scales, including pain (WOMAC-P), stiffness (WOMAC-S) and physical function (WOMAC-F), were assessed and recorded at baseline, 30minutes after the 1st injection, immediately prior to the 2nd and 3rd injections and 3 months after the 3rd injection. ResultsDemographic data were comparable between groups. The NRS after 3 months was significantly lower in group I (P=0.001). The WOMAC-P, immediately prior to the 3rd injection and 3 months afterwards, was significantly lower in group I (P=0.006, P=0.001, respectively). The WOMAC-S was improved prior to the 3rd injection and sustained until 3 months in group I (P=0.035, P=0.004, respectively). The WOMAC-F was improved after the 1st injection and sustained until 3 months in group I (P=0.002, P<0.0001 and P<0.0001, respectively). ConclusionsIntra-articular 0.5% lidocaine injection under ultrasound guidance has a potential role in the management of chronic knee pain due to osteoarthritis for a 3-month period.

Concurrent validity of different functional and neuroproteomic pain assessment methods in the rat osteoarthritis monosodium iodoacetate (MIA) model.

BackgroundLack of validity in osteoarthritis pain models and assessment methods is suspected. Our goal was to 1) assess the repeatability and reproducibility of measurement and the influence of environment, and acclimatization, to different pain assessment outcomes in normal rats, and 2) test the concurrent validity of the most reliable methods in relation to the expression of different spinal neuropeptides in a chemical model of osteoarthritic pain.MethodsRepeatability and inter-rater reliability of reflexive nociceptive mechanical thresholds, spontaneous static weight-bearing, treadmill, rotarod, and operant place escape/avoidance paradigm (PEAP) were assessed by the intraclass correlation coefficient (ICC). The most reliable acclimatization protocol was determined by comparing coefficients of variation. In a pilot comparative study, the sensitivity and responsiveness to treatment of the most reliable methods were tested in the monosodium iodoacetate (MIA) model over 21 days. Two MIA (2 mg) groups (including one lidocaine treatment group) and one sham group (0.9 % saline) received an intra-articular (50 μL) injection.ResultsNo effect of environment (observer, inverted circadian cycle, or exercise) was observed; all tested methods except mechanical sensitivity (ICC <0.3), offered good repeatability (ICC ≥0.7). The most reliable acclimatization protocol included five assessments over two weeks. MIA-related osteoarthritic change in pain was demonstrated with static weight-bearing, punctate tactile allodynia evaluation, treadmill exercise and operant PEAP, the latter being the most responsive to analgesic intra-articular lidocaine. Substance P and calcitonin gene-related peptide were higher in MIA groups compared to naive (adjusted P (adj-P) = 0.016) or sham-treated (adj-P = 0.029) rats. Repeated post-MIA lidocaine injection resulted in 34 times lower downregulation for spinal substance P compared to MIA alone (adj-P = 0.029), with a concomitant increase of 17 % in time spent on the PEAP dark side (indicative of increased comfort).ConclusionThis study of normal rats and rats with pain established the most reliable and sensitive pain assessment methods and an optimized acclimatization protocol. Operant PEAP testing was more responsive to lidocaine analgesia than other tests used, while neuropeptide spinal concentration is an objective quantification method attractive to support and validate different centralized pain functional assessment methods.

Point-of-Care Ultrasound in Diagnosis and Treatment of Luxatio Erecta (Inferior Shoulder Dislocation)

BackgroundPoint-of-care-ultrasound (POC-US) is an increasingly popular tool in the assessment of a wide variety of emergency department patients. In this case report we discuss how POC-US aided in the diagnosis and treatment of inferior shoulder dislocation, a rare presentation of a common emergency department complaint. Case ReportA 69-year-old female presented to the emergency department with severe shoulder pain after a ground level fall. Her arm was held overhead with her shoulder trapped in abduction. POC-US confirmed the diagnosis of inferior shoulder dislocation, guided glenohumeral intraarticular anesthesia, and confirmed successful reduction.Why an emergency physician should be aware of this: POC-US is a useful tool for the emergency physician when confronted with shoulder dislocation. US not only confirms the dislocation, but also differentiates between anterior versus posterior versus inferior dislocation. POC-US can guide the placement of intraarticular lidocaine for anesthesia which then potentially reduces time, expense, and risk of procedural sedation. Finally, POC-US may reduce failed reductions by providing immediate visual confirmation and in the case of reductions performed under sedation, may prevent the need for repeat sedation.

Intra-articular lidocaine versus intravenous sedative and analgesic for reduction of anterior shoulder dislocation

ObjectiveThis prospective clinical trial was performed to compare the safety and efficiency of intra-articular lidocaine (IAL) versus intravenous sedative and analgesic (IVSA) in reduction of anterior shoulder dislocation. Materials and methodsPatients with anterior shoulder dislocation were randomly divided into 2 groups to receive IAL and IVSA. One group patients received an intravenous dose of 0.05 mg/kg midazolam and 1 μg/kg fentanyl, while the other group received 20 mL intra-articular lidocaine (1%). Patient satisfaction (via a standard 5-choice questionnaire), pain score (based on visual analog scale ranging from 0 to 10 points), comfort reduction, recovery time, and side effects were recorded and compared between the two groups before, during and after the reduction procedure. ResultsTotally 104 patients with acute anterior shoulder dislocation and the mean age of 28.75 ± 7.24 years were included (86.5% male). There was no statistically significant difference between IAL and IVSA groups regarding age (p = 0.45) and gender (p = 0.25). A total of forty-seven (45.2%) patients, distributed in both groups, had a history of anterior shoulder dislocation. A significant difference was seen with regard to diminished pain intensity during reduction in IAL group (p < 0.001); Complications including nausea, apnea, hypoxia and headache were only observed in IVSA group, and there was no adverse effect in IAL group; increased patient satisfaction in IVSA group (p = 0.007); similar success rate at first attempt of reduction in both groups, and a shorter time to discharge in IAL group (p < 0.001). ConclusionIt seems that the use of intra-articular lidocaine for reduction of anterior shoulder dislocation is effective, safe, and time saving in the emergency department and has few complications. It can be considered as the first line analgesia in managing anterior shoulder dislocation.

Disruptive Knee Pain in a Cross Country Runner

HISTORY: An 18 year old male cross country runner presented to the office for non-radiating sharp lateral right knee pain. He was running approximately 20 miles per week. His pain progressively worsened over the past 10 months and he could no longer run. He had no pain at rest or while walking, and no locking, clicking, snapping, or buckling. His knee did swell mildly the last time he ran. There was no trauma and he never experienced any back or hip pain. He was initially seen by his PMD who diagnosed him with a knee sprain and prescribed physical therapy (PT), rest, ice, naproxen, and ordered an MRI. The MRI showed a trace knee effusion, but was otherwise negative. After completing PT with no relief, he was referred to a sports medicine orthopedist who diagnosed him with IT band friction syndrome and continued PT with rest. He did not improve and had a landmark based cortisone injection into the distal IT band with no relief. PHYSICAL EXAMINATION: Right knee exam: normal alignment and gait, no effusion, and tender lateral joint line. Quadriceps and hamstring strength was 4/5 with 100 loss of flexion. Positive Noble’s and McMurray test. All other provocative tests were negative, including Ober. Hip exam normal DIFFERENTIAL DIAGNOSIS: IT band syndrome Occult lateral meniscus tear Patellofemoral pain syndrome Loose body TEST AND RESULTS: MRI T2 STIR images showed a subtle signal abnormality between the IT band and the lateral femoral condyle consistent with IT band friction syndrome and a minimal linear signal abnormality posterior of the lateral meniscus junction within the distal strut in the popliteus hiatus of indeterminate significance. The posterolateral corner structures were normal. A dynamic study of an ultrasound guided cortisone injection into the distal IT band insertion and then running directly afterward and at one week produced no relief. An intra-articular lidocaine injection and running directly afterward produced complete resolution of symptoms. FINAL WORKING DIAGNOSIS: Meniscal capsular disruption TREATMENT AND OUTCOMES: He had a knee arthroscopy that repaired the meniscal capsular junction tear and a hypermobile lateral meniscus. After repair, bone marrow aspirate concentrate was injected into the posterior lateral capsule. He completed post-operative PT and is now long distance running pain-free.

Chondrogenic Effect of Intra-articular Hypertonic-Dextrose (Prolotherapy) in Severe Knee Osteoarthritis

BackgroundDextrose injection is reported to improve knee osteoarthritis (KOA)−related clinical outcomes, but its effect on articular cartilage is unknown. A chondrogenic effect of dextrose injection has been proposed. ObjectiveTo assess biological and clinical effects of intra-articular hypertonic dextrose injections (prolotherapy) in painful KOA. DesignCase series with blinded arthroscopic evaluation before and after treatment. SettingPhysical medicine and day surgery practice. ParticipantsSymptomatic KOA for at least 6 months, arthroscopy-confirmed medial compartment exposed subchondral bone, and temporary pain relief with intra-articular lidocaine injection. InterventionFour to 6 monthly 10-mL intra-articular injections with 12.5% dextrose. Main Outcome MeasuresVisual cartilage growth assessment of 9 standardized medial condyle zones in each of 6 participants by 3 arthroscopy readers masked to pre-/postinjection status (total 54 zones evaluated per reader); biopsy of a cartilage growth area posttreatment, evaluated using hematoxylin and eosin and Safranin-O stains, quantitative polarized light microscopy, and immunohistologic cartilage typing; self-reported knee specific quality of life using the Western Ontario McMaster University Osteoarthritis Index (WOMAC, 0-100 points). ResultsSix participants (1 female and 5 male) with median age of 71 years, WOMAC composite score of 57.5 points, and a 9-year pain duration received a median of 6 dextrose injections and follow-up arthroscopy at 7.75 months (range 4.5-9.5 months). In 19 of 54 zone comparisons, all 3 readers agreed that the posttreatment zone showed cartilage growth compared with the pretreatment zone. Biopsy specimens showed metabolically active cartilage with variable cellular organization, fiber parallelism, and cartilage typing patterns consistent with fibro- and hyaline-like cartilage. Compared with baseline status, the median WOMAC score improved 13 points (P = .013). Self-limited soreness after methylene blue instillation was noted. ConclusionsPositive clinical and chondrogenic effects were seen after prolotherapy with hypertonic dextrose injection in participants with symptomatic grade IV KOA, suggesting disease-modifying effects and the need for confirmation in controlled studies. Minimally invasive arthroscopy (single-compartment, single-portal) enabled collection of robust intra-articular data. Level of EvidenceIV

A case of ST-segment elevation myocardial infarction due to intraarticular lidocaine instillation.

2016;11(3-4):97. VII. nacionalni sastanak o kardiovaskularnim intervencijama s međunarodnim sudjelovanjem VI. sastanak intervencijskih kardioloskih medicinskih sestara i tehnicara Introduction: Lidocaine is an essential drug used as a local anesthetic and as antiarrhythmic medication of the class Ib type. There are multiple reports in literature that lidocaine can cause coronary artery spasm both in vitro and in vivo1,2. Elevation of the ST-segment is described during dental or neurosurgical procedures using locoregional lidocaine anesthesia2,3. We present a case in which intra-articular lidocaine instillation caused a vasospastic ST-segment elevation myocardial infarction (STEMI).

Central Sensitization and Neuropathic Features of Ongoing Pain ina Rat Model of Advanced Osteoarthritis.

Osteoarthritis (OA) pain is most commonly characterized by movement-triggered joint pain. However, in advanced disease, OA pain becomes persistent, ongoing and resistant to treatment with nonsteroidal anti-inflammatory drugs (NSAIDs). The mechanisms underlying ongoing pain in advanced OA are poorly understood. We recently showed that intra-articular (i.a.) injection of monosodium iodoacetate (MIA) into the rat knee joint produces concentration-dependent outcomes. Thus, a low dose of i.a. MIA produces NSAID-sensitive weight asymmetry without evidence of ongoing pain and a high i.a. MIA dose produces weight asymmetry and NSAID-resistant ongoing pain. In the present study, palpation of the ipsilateral hind limb of rats treated 14days previously with high, but not low, doses of i.a. MIA produced expression of the early oncogene, FOS, in the spinal dorsal horn. Inactivation of descending pain facilitatory pathways using a microinjection of lidocaine within the rostral ventromedial medulla induced conditioned place preference selectively in rats treated with the high dose of MIA. Conditioned place preference to intra-articular lidocaine was blocked by pretreatment with duloxetine (30mg/kg, intraperitoneally at -30minutes). These observations are consistent with the likelihood of a neuropathic component of OA that elicits ongoing, NSAID-resistant pain and central sensitization that is mediated, in part, by descending modulatory mechanisms. This model provides a basis for exploration of underlying mechanisms promoting neuropathic components of OA pain and for the identification of mechanisms that might guide drug discovery for treatment of advanced OA pain without the need for joint replacement. Difficulty in managing advanced OA pain often results in joint replacement therapy in these patients. Improved understanding of mechanisms driving NSAID-resistant ongoing OA pain might facilitate development of alternatives to joint replacement therapy. Our findings suggest that central sensitization and neuropathic features contribute to NSAID-resistant ongoing OA joint pain.

Hypertonic-Dextrose Intra-Articular Injections in Severe Knee Osteoarthritis: A Pilot Study Suggesting Disease Modification through Chondrogenesis

Objective(s): To assess biological and clinical effects of intra-articular hypertonic dextrose injections in painful severe knee osteoarthritis (KOA). Hypertonic dextrose injection is reported to improve KOA-related pain, stiffness and function, but its effect on articular cartilage is unknown. Design: Open label pilot study. Setting: Outpatient pain medicine and day surgery practice. Participants: Adults with knee pain for at least 6 months, arthroscopyconfirmed medial compartment Outerbridge IV KOA, and temporary pain relief with intra-articular lidocaine injection. Interventions: 6 monthly 10 mL intra-articular injections with 12.5% dextrose. Main Outcome Measure(s): Assessed at baseline and 7.5 2.0 (range 4.59.5) months: Video arthroscopy of 9 standardized medial condyle zones was performed before and after treatment; semi-quantitative visual cartilage growth assessment of each zone (+1.0,-1) was performed by 3 surgeon-reviewers. Biopsies of cartilage growth-area was obtained posttreatment and evaluated using HE Fleiss kappa Z0.901).Biopsy specimens showed metabolically active cartilage with variable cellular organization, fiber parallelism, and cartilage typing patterns consistent with fibroand hyaline-like cartilage. Compared with baseline status, participants reported improved WOMAC scores (17.6 4.7 points; pZ.013). Self-limited soreness after methylene-blue instillation was noted. Conclusions: Positive clinical and chondrogenic effects were seen after hypertonic dextrose injection in symptomatic grade IV KOA suggesting disease-modifying effects and the need for confirmation in controlled studies.

Intra-articular administration of lidocaine plus adrenaline in dogs: Pharmacokinetic profile and evaluation of toxicity in vivo and in vitro

The aim of this study was to evaluate the safety of intra-articular (IA) lidocaine plus adrenaline for improving peri-operative analgesia in anaesthetized dogs undergoing arthroscopy of the elbow. A solution of lidocaine (L) 1.98% plus adrenaline 1:100.000 was administered via the IA route and its safety evaluated in terms of cardio-, neuro-, and chondro-toxicity.No bradycardia or hypotension was recorded from induction to the last observational time point. Signs of toxicity of the nervous system could have been masked by the general anaesthesia but lidocaine concentrations detected in the blood were lower than those thought to be capable of producing toxicity. The assessment of in vitro chondrotoxicity showed a dose- and time-dependent effect of lidocaine on the viability of articular cells. Adrenaline appeared to reduce the chondrotoxicity of 1% lidocaine, following an exposure of up to 30 min.

Is there randomized controlled trial evidence to support the use of intra-articular lidocaine instead of intravenous analgesia for manual reduction of acute anterior shoulder dislocation?

Is there randomized controlled trial evidence to support the use of intra-articular lidocaine instead of intravenous analgesia for manual reduction of acute anterior shoulder dislocation?

Intra-articular lidocaine versus intravenous analgesia and sedation for manual closed reduction of acute anterior shoulder dislocation: an updated meta-analysis

Study ObjectiveTo compare intra-articular lidocaine (IAL) with intravenous analgesia and sedation (IVAS) for manual closed reduction of acute anterior shoulder dislocation. DesignMeta-analysis. SettingMetropolitan medical university. MeasurementsA literature search was conducted of PubMed, Ovid and Cochrane Library, to identify randomized controlled trials (RCTs) published from January 1, 1990 to September 1, 2012, that compared IAL with IVAS for manual closed reduction of acute anterior shoulder dislocation. Effective data were pooled using fixed-effects or random-effects models with mean differences (MDs) and risk ratios (RRs) for continuous and dichotomous variables, respectively. Main ResultsNine RCTs comprising 438 patients were analyzed. Statistical analyses showed that IAL was superior to IVAS with respect to lower complication risk (P < 0.00001) and shorter mean hospital length of stay (P = 0.03). No significant differences were noted in success of joint reduction (P = 0.16), patient satisfaction (P = 0.12), or postreduction pain relief (P = 0.76). However, IAL required more time than IVAS from injection to reduction (P < 0.00001). Subgroup analyses showed that IVAS was associated with higher risks of respiratory depression (P < 0.0001), vomiting (P = 0.04), and thrombophlebitis (P = 0.008), but no statistical differences were identified in nausea (P = 0.06), hypotension (P = 0.10), drowsiness (P = 0.45), or headache (P = 0.29). ConclusionsIntra-articular lidocaine injection may be safer than IVAS because there are fewer risks of postoperative complications with IAL. Both techniques are similarly effective for manual closed reduction of acute anterior shoulder dislocation.

Intra-articular Lidocaine for Reduction of Shoulder Dislocation

Pediatric Emergency Care: May 2014 - Volume 30 - Issue 5 - p 363-365 doi: 10.1097/01.pec.0000449812.06097.b8