J Korean Soc Spine Surg.  2014 Mar;21(1):48-55. 10.4184/jkss.2014.21.1.48.

Comparison of Lidocaine and Bupivacaine in Lumbar Medial Branch Block

• Moon SH
• Roh JH
• Lee S
• Kim J
• Shin WS

• KMID: 1840417
• DOI: http://doi.org/10.4184/jkss.2014.21.1.48

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 in posterior facet joint syndrome.

Keyword

Bupivacaine; Lidocaine; Medial branch block; Ultrasound

MeSH Terms

Bupivacaine*
Humans
Lidocaine*
Low Back Pain
Multivariate Analysis
Needles
Retrospective Studies
Spinal Nerves
Ultrasonography
Visual Analog Scale
Zygapophyseal Joint
Bupivacaine
Lidocaine

Figure

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  Fig. 1. The photograph shows sterile draping and preparation for ultra-sound-guided medial branch block.

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  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.

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  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.

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  Fig. 4. Transverse scan shows spinous process(S), facet(F) and transverse process(T).

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  Fig. 5. Move ultrasound probe laterally until transverse process and superior articular process can be located at center of image.

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  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.

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  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.

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