Manchikanti L, Pampati V, Fellows B, Bakhit C E
Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, KY 42003, USA.
Pain Physician. 1999 Oct;2(3):59-64.
This prospective study was designed to determine the prevalence of lumbar facet joint pain in a consecutive series of patients with chronic low back pain treated at an interventional, multidisciplinary private pain management practice utilizing double diagnostic blocks, to determine the prevalence of false positive rate of uncontrolled facet joint blocks, and to determine the relationship of clinical features of responders and non-responders to double diagnostic blocks. One hundred and twenty patients with low back pain with or without lower extremity pain were selected. The procedure consisted of diagnostic blocks using lidocaine and bupivacaine on separate occasions, usually two weeks apart. Each facet joint nerve was infiltrated with either 0.4 to 0.6 ml of 1% lidocaine (Xylocaine(R)) or 1% lidocaine (Xylocaine(R)) and 0.25% bupivacaine (Marcaine(R)). A definite response was defined as substantial with at least 75% relief of pain in the symptomatic area following local anesthetic block. Confirmatory blocks using bupivacaine 0.25% were performed at the same levels as the first injection if definite relief was obtained. The response to bupivacaine blocks which lasted longer than the lidocaine blocks was accepted as a positive response. All blocks were performed under fluoroscopic guidance. Eighty-one patients (67.5%) reported a definite response to lidocaine blocks. Confirmatory blocks with bupivacaine were performed in all 81 patients with 54 patients, i.e. 45% of total sample or 66.6% of lidocaine positive group reporting definite response with a false positive rate of 41%. Prevalence and relationship of pain referral pattern in patients with and without facet joint pain confirmed by double blocks showed no significant correlation. We found no relationship between the history, physical findings, age, gender, trauma, duration of pain, and diagnostic blocks. However, history of previous surgery showed a negative correlation as only 29% of the patients after previous surgery were positive in contrast to 51% of the nonsurgical population. The results of this study echo previous concerns of reliability of uncontrolled single blocks, history, and clinical features. This study demonstrated that the facet joint is a source of pain in 45% of the patients suffering with chronic low back pain in an interventional pain management setting in a private practice.
这项前瞻性研究旨在确定在一家介入性、多学科的私人疼痛管理诊所接受治疗的一系列慢性下腰痛患者中腰椎小关节疼痛的患病率，确定未控制的小关节阻滞假阳性率的患病率，并确定对双重诊断阻滞有反应者和无反应者的临床特征之间的关系。选择了120例有或无下肢疼痛的下腰痛患者。该过程包括在不同时间使用利多卡因和布比卡因进行诊断性阻滞，通常间隔两周。每个小关节神经用0.4至0.6毫升1%利多卡因（赛罗卡因）或1%利多卡因（赛罗卡因）和0.25%布比卡因（耐乐品）进行浸润。明确的反应定义为在局部麻醉阻滞后，症状区域疼痛至少减轻75%。如果获得明确缓解，则在与第一次注射相同的水平使用0.25%布比卡因进行确认性阻滞。对布比卡因阻滞的反应持续时间长于利多卡因阻滞被视为阳性反应。所有阻滞均在透视引导下进行。81例患者（67.5%）报告对利多卡因阻滞有明确反应。所有81例患者均使用布比卡因进行了确认性阻滞，其中54例患者，即占总样本的45%或利多卡因阳性组的66.6%报告有明确反应，假阳性率为41%。双重阻滞证实有或无小关节疼痛患者的疼痛放射模式的患病率及关系无显著相关性。我们发现病史、体格检查结果、年龄、性别、创伤、疼痛持续时间和诊断性阻滞之间没有关系。然而，既往手术史显示呈负相关，因为既往手术后只有29%的患者呈阳性，而非手术人群为51%。这项研究的结果呼应了之前对未控制的单次阻滞的可靠性、病史和临床特征的担忧。这项研究表明，在私人诊所的介入性疼痛管理环境中，45%的慢性下腰痛患者的小关节是疼痛来源。
