Comparison of Lidocaine and Bupivacaine in Lumbar Medial Branch Block

Sang Ho Moon; Jang Ho Roh; Song Lee; Jeehyoung Kim; Won Shik Shin

doi:10.4184/jkss.2014.21.1.48

Journal List > J Korean Soc Spine Surg > v.21(1) > 1076043

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Moon, Roh, Lee, Kim, and Shin: Comparison of Lidocaine and Bupivacaine in Lumbar Medial Branch Block

Original Article

Journal of Korean Spine Surg 2014;21(1):48-55.

Published online: 21 March 2014

DOI: https://doi.org/10.4184/jkss.2014.21.1.48

Comparison of Lidocaine and Bupivacaine in Lumbar Medial Branch Block

Sang Ho Moon, M.D., Jang Ho Roh, M.D.¹, Song Lee, M.D., Jeehyoung Kim, M.D., Won Shik Shin, M.D.

Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea

¹Yonsei Jin Pain Clinic, Seoul, Korea

Corresponding author: Sang Ho Moon, M.D. Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital 40-12, Chungryangri-dong, Dongdaemoon-gu, Seoul, 130-011, Korea TEL: 82-2-966-1616, FAX: 82-2-968-2394 E-mail: msh124@paran.com

Received 28 June 2013 Revised 5 July 2013 Accepted 9 December 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

This is a retrospective clinical study.

Objectives

To compare the efficacy of lidocaine and bupivacaine for the ultrasound-guided lumbar medial branch block in chronic low back pain.

Summary of Literature Review

There is no study for comparison of the efficacy between lidocaine and bupivacaine for the medial branch block.

Materials and Methods

From August 2011 to May 2013, 186 patients were assigned 0.5% lidocaine(n=136) or 0.25% bupivacaine(n=45) for the ultrasound-guided lumbar medial branch block. All procedures have been performed by the same operator, and 23G, 10 cm needle was placed and drug was injected under ultrasound guide. To target medial branches from lumbar spinal nerve, the groove at the root of transverse process and the base of superior articular process has been identified on transverse scan. Patients were evaluated by pre- and post-interventional(1 hour) Visual Analog Scale and analyzed statistically.

Results

Reduction of VAS score in bupivacaine group is significantly greater than that in lidocaine group and post-interventional VAS score in bupivacaine group is significantly lower than that in lidocaine group through analysis of covariance test with adjusted pre-interventional VAS score. In multivariate analysis, while age, sex and treatment level were not significant factors, pre-interventional VAS score and the kind of drug were significant factors. Severe pain before treatment and bupivacaine was indicator of better result. Bupivacaine group reduced pain score in the VAS 2.285 more than lidocaine group with adjustment with other factors.

Conclusions

Bupivacaine is more effective than lidocaine in the reduction of pain after ultrasound-guided lumbar medial branch blocks

Keywords: Bupivacaine, Lidocaine, Medial branch block, Ultrasound

REFERENCES

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Figures and Tables%

Fig. 1.

The photograph shows sterile draping and preparation for ultra-sound-guided medial branch block.

Fig. 2.

Ultrasonography on longitudinal scan at midline of lumbar area shows cephalad part of spinous process in sacrum as landmark from which other lumbar spinous processes can be counted upwards. S1; spinous process (median sacral crest) of sacrum, L5; spinous process of 5th lumbar vertebra, L4; spinous process of 4th lumbar vertebra.

Fig. 3.

Target facet segment can be counted by longitudinal paravertebral sonogram corresponding with previously checked spinous process. L5S1; facet joint between sacrum and 5th lumbar vertebra, L45; facet joint between 4th and 5th lumbar vertebra, L34; facet joint between 3rd and 4th lumbar vertebra.

Fig. 4.

Transverse scan shows spinous process(S), facet(F) and transverse process(T).

Fig. 5.

Move ultrasound probe laterally until transverse process and superior articular process can be located at center of image.

Fig. 6.

(A) Doppler scan shows multiple red spots which indicate vascularity around posterior muscular structure. (B) Imaginary pathway(white arrow) for needle avoiding vessles.

Fig. 7.

23G, 10cm needle (arrowheads) is introduced by use of real-time in-plane ultrasound guidance to target point, which is groove at root of transverse process and base of superior articular process.

Table 1.

Baseline characteristic and demography of patients

	Lidocaine group (N=136)	Bupivacaine group (N=45)	Significance (p value)
Age (mean years)	56	54	0.5901
(interquartile range)	(47, 66)	(45, 64)
Sex (male : female)	50 : 86	23 : 22	0.1272
Left : Right : Both	74 : 51 : 11	25 : 19 : 1	0.3757
Level (1 level; 2 level; 3 level)	84 : 44 : 6	22 : 17 : 6	0.0633
Preop. VAS score (median)	7	9	0.0004
(interquartile range)	(6, 8)	(7, 9)

Table 2.

postMBB VAS and improved VAS adjusted with preMBB VAS

	Lidocaine (N=136)	Bupivacaine (N=45)	Significance
Improved VAS (mean±standard deviation)	4.691±1.852	7.7±1.698	0.000^*
PostMBB VAS (mean±standard deviation)	2.412±2.203	0.622±0.936	0.000^*

*ANCOVA with adjusted by preMBB VAS

Table 3.

Multi variable analysis with multiple regression

Variables	Coefficient	95% Confidence Interval of Coefficient	Significance
Age	0.007		0.4398
Sex (male vs female)	-0.158		0.5553
Level
1 level	1
2 level	-0.091		0.7456
3 level	0.897		0.1370
4 level	0.773		0.5362
Preop. VAS	0.369	(0.02079, 0.05296)	0.0000^*
Bupivacaine vslidocaine	2.285	(1.6620, 2.9079)	0.0000^*

^∗ means p<0.05

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