Woo Jae Hee, Park Hahck Soo
Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
Pain Med. 2015 Jan;16(1):61-7. doi: 10.1111/pme.12582. Epub 2014 Oct 7.
Intra-arterial injections of local anesthetic during cervical transforaminal epidural block (TFEB) can cause rare but fatal neurologic complications. We hypothesized that using a dose of local anesthetic lower than seizure threshold during cervical TFEB would not be associated with seizure activity in cases of accidental intra-arterial injection.
Patients were randomized to one of two groups: group I received injections of 1 mL of 1% lidocaine mixed with dexamethasone 2.5 mg (n = 15), and group II received 1 mL of 0.125% lidocaine mixed with dexamethasone 2.5 mg (n = 15). When the numeric rating scale (NRS) for pain was greater than 3, cervical TFEBs were performed three times at 2-week intervals. Patients were evaluated up to 3 months.
Thirty patients with cervical radicular pain were enrolled in this study. The NRS pain score on the day of procedure and at 2 weeks, 4 weeks, 6 weeks, and 3 months following the initial procedure were similarly significantly reduced in both groups. The total number of procedures performed and the outcomes evaluated according to Odom's criteria at the 3-month follow-up visit were not different between groups. Overall, 73.3% and 80% patients in groups I and II, respectively, rated the degree of their symptom relief as excellent or good.
Cervical TFEB performed using 0.125% lidocaine with dexamethasone achieved similar satisfactory effects as 1% lidocaine with dexamethasone for the treatment of cervical radicular pain. Therefore, the use of low-dose lidocaine with dexamethasone is reasonable for cervical TFEB, as this may reduce the incidence of rare but fatal complications.
在颈椎椎间孔硬膜外阻滞（TFEB）期间动脉内注射局部麻醉药可导致罕见但致命的神经并发症。我们推测，在颈椎TFEB期间使用低于惊厥阈值剂量的局部麻醉药，在意外动脉内注射的情况下不会与惊厥活动相关。
患者被随机分为两组之一：第一组接受1毫升1%利多卡因与2.5毫克地塞米松混合液的注射（n = 15），第二组接受1毫升0.125%利多卡因与2.5毫克地塞米松混合液的注射（n = 15）。当疼痛数字评定量表（NRS）大于3时，每隔2周进行3次颈椎TFEB。对患者进行长达3个月的评估。
30例颈椎神经根性疼痛患者纳入本研究。两组在手术当天以及初次手术后2周、4周、6周和3个月时的NRS疼痛评分均同样显著降低。两组在3个月随访时根据奥多姆标准进行的手术总数和评估结果没有差异。总体而言，第一组和第二组分别有73.3%和80%的患者将其症状缓解程度评为优秀或良好。
使用0.125%利多卡因与地塞米松进行颈椎TFEB，在治疗颈椎神经根性疼痛方面与使用1%利多卡因与地塞米松取得了相似的满意效果。因此，使用低剂量利多卡因与地塞米松进行颈椎TFEB是合理的，因为这可能会降低罕见但致命并发症的发生率。
