Does Cervical Interlaminar Epidural Steroid Injection with Low-Dose Lidocaine Cause Objective Upper Extremity...

Area of Science:

• Pain Medicine
• Neurology
• Anesthesiology

Background:

• Cervical interlaminar epidural steroid injections (CIESI) commonly utilize local anesthetics.
• The impact of low-dose lidocaine on upper extremity strength post-CIESI is not well-documented.
• Potential for post-procedure weakness raises safety concerns.

Purpose of the Study:

• To investigate if low-dose lidocaine administered during CIESI at C7-T1 causes objective upper extremity weakness.
• To quantify the extent and incidence of strength deficits in specific muscle groups.

Main Methods:

• Prospective case series involving adult patients with cervical radicular pain.
• CIESI performed with 1 mL of 1% lidocaine (3 mL total injectate).
• Elbow flexion, wrist extension, elbow extension, and handgrip strength measured by dynamometry at baseline, 15, and 30 minutes post-injection.

Main Results:

• No significant overall within-participant strength difference from baseline observed at 15 or 30 minutes.
• However, 19% of participants showed a ≥20% strength decrease in at least one myotomal distribution.
• Specific deficits included up to 7% for right elbow flexion and wrist extension.

Conclusions:

• CIESI using 3 mL injectate with 1 mL of 1% lidocaine can lead to objective upper extremity weakness.
• This weakness may exceed the minimum threshold of perception in a subset of patients.
• Findings highlight the need to consider potential transient motor deficits post-procedure.