Intra-articular Lidocaine Research Articles

Evidence in orthopaedics: comparison of intra-articular lidocaine vs. intravenous analgesia and sedation for reduction of acute shoulder dislocation

Acute shoulder dislocation is the most common joint dislocation managed in emergency department. It has been commonly treated with closed reduction and the use of intravenous analgesia and sedation (IVAS). Recently, intra-articular lidocaine (IAL) has been advocated as an alternative to sedation, since intravenous access and patient monitoring are not required. A careful literature analysis was performed to establish which anesthetic method is best indicated to reach a reduction that is easily performed, effective, relatively painless and safe, and to allow for expeditious discharge of the patient. To find the best evidence on the topic, we searched in the Cochrane Library, Health Technology Assessment (HTA) database, TRIP, Medline, CINAHL, and EMBASE. In the four prospective randomized clinical trials found, no statistically significant difference was detected between IAL and IVAS for reduction of acute anterior shoulder dislocations with regard to pain score, difficulty of reduction, and success rate. Although we cannot definitively state which is the best anesthetic method, we conclude that intra-articular injection of lidocaine is an excellent alternative for those patients for whom IVAS is not indicated.

Intra-articular lidocaine or intravenous sedation for reduction of shoulder dislocations?

Intra-articular lidocaine or intravenous sedation for reduction of shoulder dislocations?

Intra-articular lidocaine plus bupivacaine in sheep undergoing stifle arthrotomy

ObjectiveTo evaluate the effect of intra-articular (IA) lidocaine plus bupivacaine on post-operative pain in sheep undergoing stifle arthrotomy. Study designRandomized controlled experimental trial. AnimalsSixteen adult Rambouillet-cross ewes. MethodsSheep were randomly assigned to one of two treatment groups. The lidocaine/bupivacaine group (L/B, n = 8) received IA lidocaine (40 mg (2 mL)) prior to incision and IA bupivacaine (10 mg (2 mL)) post-closure, while the control group (n = 8) received no IA injections. IA local anesthetics were an addition to the standard analgesic protocol of phenylbutazone (1 g orally, every 24 hours for 5 days) and transdermal fentanyl (equivalent to 15 mg), initiated 24 hours prior to surgery. A stifle arthrotomy was performed with the purpose of creating a full-thickness articular cartilage defect. Two observers blinded to treatment assessed sheep for total pain score using a numeric ranking scale that included: comfort, movement, and flock behavior. The first observation (T = 0) was obtained the evening of surgery (3–7 hours post-operatively); subsequent observations occurred every 12 hours for 72 hours. Nonparametric statistical tests were used to evaluate differences between groups for total pain score. ResultsL/B sheep had significantly lower total pain scores at T = 0 than control sheep (p < 0.05). No significant differences between treatments were noted at any subsequent time periods. There were no differences attributable to the use of different observers. Conclusions and clinical relevanceIA lidocaine plus bupivacaine provided analgesia at 3–7 hours post-operatively. Use of IA lidocaine and bupivacaine is a simple, effective, yet inexpensive perioperative analgesic protocol for joint surgery in sheep.

Comparison of intra-articular lidocaine and intravenous sedation for reduction of shoulder dislocations: A randomized, prospective study

Comparison of intra-articular lidocaine and intravenous sedation for reduction of shoulder dislocations: A randomized, prospective study

Local anesthetics differentially inhibit sympathetic neuron-mediated and C fiber-mediated synovial neurogenic plasma extravasation.

Local anesthetics are used for local irrigation after many types of operations. However, recent evidence of toxic effects of local anesthetics at large concentrations during continuous administration suggests an advantage of using decreased local anesthetic concentrations for irrigation solutions. In this study, we determined whether smaller concentrations of local anesthetics may maintain an antiinflammatory and, therefore, analgesic effect without the risk of possible toxicity. Lidocaine and bupivacaine were studied for their ability to inhibit both components of neurogenic inflammation-C fiber-mediated and sympathetic postganglionic neuron (SPGN)-mediated inflammation-in the rat knee joint. Intraarticular lidocaine 0.02% reduced 5-hydroxytryptamine (5-HT)-induced (SPGN-mediated) plasma extravasation (PE) by 35%, and further decreases were obtained by perfusing larger concentrations of lidocaine. Intraarticular bupivacaine 0.025% inhibited 5-HT-induced PE by 60%, and a 95% inhibition was obtained with bupivacaine 0.05%. Larger local anesthetic concentrations were necessary to inhibit C fiber-mediated PE than those required to inhibit SPGN-mediated PE. Lidocaine 0.4% was required to reduce mustard oil-induced PE by 60%. Lidocaine 2% inhibited mustard oil-induced PE to baseline levels. Bupivacaine 0.1% was required for an 80% reduction of PE. Bupivacaine 0.25% inhibited mustard oil-induced PE to baseline levels. Our results demonstrate differential effects of local anesthetics on SPGN- and C fiber-mediated PE but confirm the concept of using smaller concentrations of local anesthetics to achieve inhibition of postoperative inflammation. Local anesthetic wound irrigation is often used to treat postoperative surgical pain. Large concentrations of local anesthetics are usually used, and these concentrations may have possible neurotoxic and myotoxic effects. Our results demonstrate antiinflammatory effects of lidocaine and bupivacaine at concentrations smaller than used clinically.

Comparative study of intra-articular lidocaine and intravenous meperidine/diazepam for shoulder dislocations

The purpose of this study was to compare the analgesic effectiveness of intra-articular lidocaine versus intravenous meperidine and diazepam during the reduction of anterior shoulder dislocations. Patients were randomized to one of the two methods before the reduction of shoulder dislocations. Patients marked a visual analog pain scale at baseline, after anesthesia just before reduction, and at the time of discharge. Interference with the procedure caused by pain or lack of muscle relaxation, perception of adequacy of analgesia by the patient, adverse effects, and time to discharge from the Emergency Department (ED) were measured. Differences of outcomes, relative risks (RR), and 95% confidence intervals (CIs) were derived. Fifty-four patients with anterior shoulder dislocations presenting from May 21, 1998 through January 21, 1999 were included in this study; 29 were randomly assigned to receive intra-articular lidocaine (IAL) and 25 to receive intravenous meperidine/diazepam (IVMD). IAL was less effective than IVMD in relieving pre-reduction pain ( p = 0.045) but equally effective in overall pain relief ( p = 0.98). IAL was more effective than IVMD in shortening recovery time ( p = 0.025). There was an indication favoring IVMD in terms of physician-perceived muscle relaxation and patient’s perception of analgesia adequacy. In conclusion, although the IVMD method appears to have some clinically and statistically significant advantages, IAL possesses some favorable features that render it to be an analgesia alternative in shoulder dislocation reduction.

Anesthetic methods for reduction of acute shoulder dislocations: A prospective randomized study comparing intraarticular lidocaine with intravenous analgesia and sedation

A prospective, randomized, nonblinded clinical trial was undertaken to evaluate whether local intraarticular lidocaine injection (IAL) is equally effective in facilitating reduction of acute anterior shoulder dislocations (AASD) as intravenous analgesia/sedation (IVAS). The setting was an urban, Level 1, trauma center. Patients enrolled presented to the emergency department (ED) with radiographically confirmed AASD and were randomized either to the IVAS group or the IAL group. Ease of reduction and pain associated with reduction were measured subjectively using a 10-point scale. There were 49 patients entered into the study, 20 in the IVAS group and 29 in the IAL group. There was no statistically significant difference between mean ± SD pain scores of 3.32 ± 2.39 in the IVAS group and 4.90 ± 2.34 in the IAL group ( P = .18), or mean ± SD ease of reduction scores of 3.32 ± 2.36 in the IVAS group and 4.45 ± 2.46 in the IAL group ( P = .12). Although IVAS tended to have a higher success rate (20 of 20) than IAL (25 of 29) in this study, Kaplan-Meier estimates for delayed time-events curves applying the log-rank test showed that this difference was not statistically significant overall ( P = .16). However, with reduction rate evaluated as a function of time delay in seeking treatment, patients presenting 5.5 hours after dislocation were more likely to fail treatment with IAL ( P = .00001). Additionally, half of the patients in the IAL group who had experience with IVAS did not favor IAL. Emergency physicians should be aware of IAL as an alternative technique that may be considered in patients when there are reasons to avoid systemic analgesia or sedation.

Glenoid cysts mimicking cervical radiculopathy.

Patients are often referred for the evaluation of neck or radiating shoulder or arm pain who are suspected of having a possible cervical spine origin of their symptoms. Careful evaluation may show ganglion cysts of the glenohumeral joint mimicking symptoms of cervical radiculopathy. To present a series of patients in whom cysts originating from the glenohumeral joint caused symptoms mimicking cervical radiculopathy. Suprascapular nerve entrapment in the suprascapular notch by ganglion cysts from the glenohumeral joint has been described as the source of vague radicular symptoms. This paper presents a series of patients referred to a spine practice for the evaluation of cervical radiculopathy who actually had glenoid cysts mimicking cervical radiculopathy. Three hundred forty-two patients were evaluated for cervical radiculopathy; of these, eight had glenoid cysts that were the source of the patients' symptoms. All eight patients had a positive shoulder impingement sign, or, in all, symptoms were temporarily relieved with intra-articular lidocaine injection. Four of the eight patients had abnormal electromyelography and nerve conduction velocity for suprascapular nerve compression. Magnetic resonance imaging of the shoulder was diagnostic in all eight patients. Proper evaluation of the shoulder must be done because it may mimic symptoms of cervical radiculopathy.

Articular complications of Paget's disease of bone

Articular symptoms in Paget's disease are very common. The most frequent cause of articular symptoms is OA, secondary to the Paget's disease. Radiographie OA due to Paget's disease is not always symptomatic, and periarticular Paget's disease does not invariably lead to OA. Intraarticular lidocaine occasionally is helpful in separating the symptoms of OA from those of Paget's disease.

Intra-Articular Lidocaine Analgesia in the Treatment of Acute Shoulder Dislocations

Intra-Articular Lidocaine Analgesia in the Treatment of Acute Shoulder Dislocations

Ultrasonographic demonstration of popliteal cysts in rheumatoid arthritis. A noninvasive technique.

Ultrasound scanning techniques detected popliteal cysts in 14 of 24 knees affected with rheumatoid arthritis and associated with an anterior effusion. Serial scans demonstrated the persistence of cysts when effusion was not controlled by intraarticular steroid and lidocaine, and regression of cyst following control of effusion with anterior synovectomy. As the technique is noninvasive, painless, and reproducible, ultrasound scanning should be the technique of choice for the detection and assessment of popliteal cysts.