title: Cervical transforaminal epidural block using low-dose local anesthetic: a prospective, randomized, double-blind study.
abstract: OBJECTIVE
  Intra-arterial injections of local anesthetic during cervical transforaminal epidural block (TFEB) can cause rare but fatal neurologic complications. We hypothesized that using a dose of local anesthetic lower than seizure threshold during cervical TFEB would not be associated with seizure activity in cases of accidental intra-arterial injection.
  
  
  METHODS
  Patients were randomized to one of two groups: group I received injections of 1 mL of 1% lidocaine mixed with dexamethasone 2.5 mg (n = 15), and group II received 1 mL of 0.125% lidocaine mixed with dexamethasone 2.5 mg (n = 15). When the numeric rating scale (NRS) for pain was greater than 3, cervical TFEBs were performed three times at 2-week intervals. Patients were evaluated up to 3 months.
  
  
  RESULTS
  Thirty patients with cervical radicular pain were enrolled in this study. The NRS pain score on the day of procedure and at 2 weeks, 4 weeks, 6 weeks, and 3 months following the initial procedure were similarly significantly reduced in both groups. The total number of procedures performed and the outcomes evaluated according to Odom's criteria at the 3-month follow-up visit were not different between groups. Overall, 73.3% and 80% patients in groups I and II, respectively, rated the degree of their symptom relief as excellent or good.
  
  
  CONCLUSIONS
  Cervical TFEB performed using 0.125% lidocaine with dexamethasone achieved similar satisfactory effects as 1% lidocaine with dexamethasone for the treatment of cervical radicular pain. Therefore, the use of low-dose lidocaine with dexamethasone is reasonable for cervical TFEB, as this may reduce the incidence of rare but fatal complications.
authors.affiliation: Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Woo
authors.forename: Hahck Soo
authors.initials: HS
authors.lastname: Park
mesh_terms: D015360:Analgesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002574:Cervical Vertebrae; D003907:Dexamethasone / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy*; D011843:Radiculopathy / Q000188:drug therapy
chemical_list: D000779:Anesthetics, Local; D005938:Glucocorticoids; D003907:Dexamethasone; D008012:Lidocaine
keywords: Cervical; Lidocaine; Safety; Transforaminal Epidural Block