Usefulness of intra-articular bupivacain and lidocain adjunction in MR or CT arthrography: a prospective study in 148 patients.
OBJECTIVE
To evaluate the influence of shorter- and longer-acting intra-articular anaesthetics on post-arthrographic pain.


METHODS
154 consecutive patients investigated by MR or CT arthrographies were randomly assigned to one of the following groups: 1--intra-articular contrast injection only; 2--lidocain 1% adjunction; or 3--bupivacain 0.25% adjunction. Pain was assessed before injection, at 15 min, 4 h, 1 day and 1 week after injection by visual analogue scale (VAS).


RESULTS
At 15 min, early mean pain score increased by 0.96, 0.24 and 0 in groups 1, 2 and 3, respectively. Differences between groups 1 & 3 and 1 & 2 were statistically significant (p=0.003 and 0.03, respectively), but not between groups 2 & 3 (p=0.54). Delayed mean pain score increase was maximal at 4 h, reaching 1.60, 1.22 and 0.29 in groups 1, 2 and 3, respectively. Differences between groups 1 & 2 and 2 & 3 were statistically significant (p=0.002 and 0.02, respectively), but not between groups 1 & 2 (p=0.46). At 24 h and 1 week, the interaction of local anaesthetics with increase in pain score was no longer significant. Results were independent of age, gender and baseline VAS.


CONCLUSIONS
Intra-articular anaesthesia may significantly reduce post-arthrographic pain. Bupivacain seems to be more effective than lidocain to reduce both early and delayed pain.
Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland. pascal.mosimann@chuv.ch
Pascal J
PJ
Mosimann
Delphine
D
Richarme
Fabio
F
Becce
Anne-Sophie
AS
Knoepfli
Vincent
V
Mino
Reto
R
Meuli
Nicolas
N
Theumann
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage; D018771:Arthralgia / Q000209:etiology* / Q000517:prevention & control*; D001175:Arthrography / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008012:Lidocaine / Q000008:administration & dosage*; D008279:Magnetic Resonance Imaging / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult
D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine