title: The Effects of Local Anesthesia Administration on Pain Experience During Interventional Spine Procedures: A Prospective Controlled Trial.
abstract: It has been postulated that local anesthetic administration may be the most painful part of interventional spine procedures. Despite this, there is a lack of evidence supporting the commonly used traditional technique of anesthetic delivery as part of these procedures. This study tested three hypotheses: 1) alternative method of local anesthesia injection is superior to the traditional method; 2) using the traditional method of injection is not superior to using no local anesthetic; and 3) treatment needle size, anesthetic injection technique, and sedation are associated with pain experienced during procedures.
  
  
  
  Prospective, multicenter clinical trial of 127 participants who underwent elective bilateral symmetric interventional spine procedures in outpatient spine clinics.
  
  
  
  Primary outcomes were pain scores during and after procedures to examine the influence of anesthetic injection method and treatment needle gauge on pain experience using linear mixed model regression analysis. A post-hoc comparison of estimated marginal mean pain scores was completed on both anesthetic injection method and treatment needle gauge.
  
  
  
  The alternative method was superior (P < 0.05) to the traditional method on post procedural pain scores. Injecting local anesthetic with the traditional or alternative method was not superior to using no local anesthetic. Treatment needle size, pain at one inch of treatment needle insertion, and baseline pain were all significantly (P < 0.05) associated with overall procedural pain. Further studies are needed optimize and justify local anesthetic injections for these procedures.
authors.affiliation: *Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan.
authors.forename: Rishi
authors.initials: R
authors.lastname: Bakshi
authors.affiliation: *Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan; hassen@med.umich.edu.
authors.forename: Hassen
authors.initials: H
authors.lastname: Berri
authors.affiliation: *Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan.
authors.forename: Claire
authors.initials: C
authors.lastname: Kalpakjian
authors.affiliation: Department of Physical Medicine and Rehabilitation, Stanford University, Redwood City, California, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Smuck
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects* / Q000379:methods; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D011446:Prospective Studies; D016037:Single-Blind Method; D013122:Spinal Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local
keywords: Injection; Lidocaine; Pain; Spine; Traditional