Lidocaine for headache prevention during chronic subdural hematoma embolization

Area of Science:

• Interventional neuroradiology
• Pain management
• Neurosurgery

Background:

• Chronic subdural hematoma (CSH) management often involves middle meningeal artery embolization (MMAE) using ethylene vinyl alcohol (EVOH).
• MMAE with EVOH can cause significant patient discomfort due to meningeal nociceptor stimulation.
• Assessing methods to mitigate pain during MMAE is crucial for patient well-being and treatment adherence.

Purpose of the Study:

• To evaluate the safety and efficacy of intra-arterial lidocaine (IAL) administration prior to MMAE for CSDH.
• To determine if IAL can reduce pain experienced by patients during EVOH embolization.
• To assess the impact of IAL on patient compliance during the procedure.

Main Methods:

• A case-control study analyzing consecutive patients with bilateral CSDH undergoing MMAE with EVOH.
• Monolateral intra-arterial lidocaine (IAL) injection was administered with casual allocation.
• Pain was assessed using the Visual Analog Scale (VAS) during embolization, comparing IAL-treated sides with control sides.
• Statistical analysis included paired t-tests and chi-squared tests, adhering to STROBE guidelines.

Main Results:

• 32 patients with bilateral CSDH underwent MMAE with EVOH between September 2021 and March 2023.
• IAL treatment led to significantly lower VAS scores (median 3) compared to the control group (median 7, p < 0.001).
• No substantial side effects were observed, and patient compliance improved with lidocaine administration.

Conclusions:

• Intra-arterial lidocaine (IAL) appears effective in reducing pain associated with EVOH injection during MMAE for CSDH.
• IAL administration may enhance patient compliance during this interventional procedure.
• IAL represents a potentially valuable adjunct for improving patient comfort in MMAE for CSDH.