Does Cervical Interlaminar Epidural Steroid Injection with Low-Dose Lidocaine Cause Objective Upper Extremity Weakness? A Preliminary Study.
OBJECTIVE
Low-dose local anesthetic is often used in cervical interlaminar epidural steroid injections (CIESI), yet its effect on upper extremity strength has not been studied. The presence of consequent weakness has potential implications for postprocedure safety. This study aimed to determine whether low-dose lidocaine in a C7-T1 CIESI causes objective weakness.


METHODS
Prospective case series.


METHODS
Academic pain center.


METHODS
Adults, cervical radicular pain.


METHODS
Participants underwent CIESI with 1 mL of 1% lidocaine (3 mL total injectate). Elbow flexion (EF), wrist extension (WE), elbow extension (EE), and handgrip strength were measured by dynamometry at baseline, 15 minutes, and 30 minutes postinjection. Changes in strength from baseline and the proportion of participants with a minimum perceptible change in EF, WE, EE, and handgrip strength (≥20%) and 95% confidence intervals (CIs) were calculated.


RESULTS
Twenty-seven participants were included. At 15 and 30 minutes postinjection, there was no within-participant difference in EF, WE, EE, and handgrip strength from baseline overall. Nonetheless, five (19%, 95% CI = 4-33) of the participants demonstrated a 20% or greater strength decrease in at least one myotomal distribution. A 20% or greater decrease in strength was present in left EF 4% (95% CI = 0-11%), right EF 7% (95% CI = 0-17%), left WE 4% (95% CI = 0-11%), and right WE 7% (95% CI = 0-17%).


CONCLUSIONS
The present data suggest that CIESI with an injectate volume of 3 mL that includes 1 mL of 1% lidocaine may result in objective upper extremity weakness that is above the minimum threshold of perception in a subset of patients.
Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, California.
Zachary L
ZL
McCormick
Department of Anesthesiology, University of California at Irvine, Irvine, California.
Ariana
A
Nelson
Department of Anesthesiology, Northwestern University, Chicago, Illinois, USA.
Mark C
MC
Kendall
Department of Anesthesiology, Northwestern University, Chicago, Illinois, USA.
Robert J
RJ
McCarthy
Department of Anesthesiology, Northwestern University, Chicago, Illinois, USA.
Geeta
G
Nagpal
Department of Anesthesiology, Northwestern University, Chicago, Illinois, USA.
David R
DR
Walega
D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001132:Arm; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D018737:Hand Strength; D006801:Humans; D007268:Injections, Epidural; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000139:chemically induced*; D019547:Neck Pain / Q000188:drug therapy; D059408:Pain Management / Q000009:adverse effects* / Q000379:methods; D011446:Prospective Studies; D011843:Radiculopathy / Q000188:drug therapy*; D014222:Triamcinolone Acetonide / Q000008:administration & dosage
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D008012:Lidocaine; D014222:Triamcinolone Acetonide
Anesthetics; Cervical Epidural Steroid; Injections; Lidocaine; Local; Muscle Strength Dynamometer; Patient Safety