Back pain following epidural anesthesia with 2-chloroprocaine (EDTA-free) or lidocaine

Severe lumbar pain following epidural injection of 2-chloroprocaine is usually associated with the Nesacaine-MPF solution available in the United States. The purpose of this study was to determine if the solution distributed in Canada (Nesacaine-CE), which contains calcium disodium edetate (0.1 mg/mL) and sodium bisulfite (0.7 mg/mL) but no disodium ethylenediaminetetraacetic acid, is associated with back pain or spasm when compared with epidural lidocaine.

With use of a prospective, double-blind, randomized design, 30 patients scheduled to undergo outpatient knee arthroscopy under epidural anesthesia were divided into two groups to received 30 mL of either Nesacaine-CE 3% (group A) or lidocaine 1.33% (group B). Postoperative pain in the lumbar area was assessed twice by a 10-cm visual analog scale (VAS) before patients left the hospital and 24 hours later by phone. The lumbar area was palpated to search for muscle spasm before discharge from hospital.

More patients receiving Nesacaine-CE than receiving lidocaine suffered from back pain in the recovery room (four vs none P = .03) and before leaving the hospital (nine vs one P = .001). Higher VAS scores (mean +/- SE) were obtained after Nesacaine CE then after lidocaine in the recovery room (0.5 +/- 0.24 vs 0.0 +/- 0.0, p = .049) and before leaving the hospital (1.8 +/- 0.5 vs 0.1 +/- 0.1, P = .001). No difference existed 24 hours later between the two groups with regard to the prevalence of back pain or VAS scores. No muscle spasm was detected.

No cases of severe backache were observed. However, epidural Nesacaine-CE 3% was associated with mild back pain, generally confined to the area of needle insertion, when compared with lidocaine 1.33%.