Abstract
OBJECTIVE: Mixtures of local anesthetics and steroids are routinely injected intraarticularly to temporarily relieve joint pain, even though local anesthetics have been reported to cause chondrocyte death in a dose- and time-dependent manner. This study aimed to determine if intraarticular injections of bupivacaine 0.5% and bupivacaine 0.25% would provide similar pain relief. MATERIALS AND METHODS: All fluoroscopically guided glenohumeral joint injections performed using 2.5 mL of bupivacaine and 0.5 mL (20 mg) of triamcinolone acetonide over a 42-month period were included if a pain score was recorded before, 5.10 minutes after, and 1 week after injection. Pain reduction of more than 2 points was considered much improved clinically with pain reduction of more than 1 point considered the minimum clinically important difference (MCID) threshold. RESULTS: Statistically significant and much improved pain reduction was achieved using both bupivacaine 0.5% and 0.25% 5.10 minutes (-3.7 points; 95% CI, -3.4 to -4.0 points; p ≤ 0.001; and.3.3 points; 95% CI, -3.0 to -3.5 points; p ≤ 0.001) and 1 week (-2.5 points; 95% CI, -2.2 to -2.9 points; p ≤ 0.001; and -2.1 points; 95% CI, -1.8 to -2.3 points; p ≤ 0.001) after injection, respectively. Adjusting for age, sex, pain score before injection, and indication, the mean decrease in pain was greater in the bupivacaine 0.5% group by 0.30 points 5.10 minutes after injection (95% CI, -0.03 to 0.63 points; p = 0.08) and 0.46 points 1 week after injection (95% CI, 0.13.0.77 points; p = 0.01). CONCLUSION: Both bupivacaine 0.5% and bupivacaine 0.25% provide statistically significant and much improved pain relief 5.10 minutes and 1 week after intraarticular glenohumeral injections. Bupivacaine 0.5% provided greater pain relief than bupivacaine 0.25%, but the difference was less than 0.5 points and therefore did not meet the MCID threshold.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 805-809 |
| Number of pages | 5 |
| Journal | American Journal of Roentgenology |
| Volume | 206 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 1 2016 |
| Externally published | Yes |
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Keywords
- Bupivacaine
- Intraarticular injections
- Local anesthetics
- Pain
- Shoulder joint
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
Cite this
Does reducing the concentration of bupivacaine when performing therapeutic shoulder joint injections impact the clinical outcome? / Fox, Michael; Patrie, James T.
In: American Journal of Roentgenology, Vol. 206, No. 4, 01.04.2016, p. 805-809.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Does reducing the concentration of bupivacaine when performing therapeutic shoulder joint injections impact the clinical outcome?
AU - Fox, Michael
AU - Patrie, James T.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - OBJECTIVE: Mixtures of local anesthetics and steroids are routinely injected intraarticularly to temporarily relieve joint pain, even though local anesthetics have been reported to cause chondrocyte death in a dose- and time-dependent manner. This study aimed to determine if intraarticular injections of bupivacaine 0.5% and bupivacaine 0.25% would provide similar pain relief. MATERIALS AND METHODS: All fluoroscopically guided glenohumeral joint injections performed using 2.5 mL of bupivacaine and 0.5 mL (20 mg) of triamcinolone acetonide over a 42-month period were included if a pain score was recorded before, 5.10 minutes after, and 1 week after injection. Pain reduction of more than 2 points was considered much improved clinically with pain reduction of more than 1 point considered the minimum clinically important difference (MCID) threshold. RESULTS: Statistically significant and much improved pain reduction was achieved using both bupivacaine 0.5% and 0.25% 5.10 minutes (-3.7 points; 95% CI, -3.4 to -4.0 points; p ≤ 0.001; and.3.3 points; 95% CI, -3.0 to -3.5 points; p ≤ 0.001) and 1 week (-2.5 points; 95% CI, -2.2 to -2.9 points; p ≤ 0.001; and -2.1 points; 95% CI, -1.8 to -2.3 points; p ≤ 0.001) after injection, respectively. Adjusting for age, sex, pain score before injection, and indication, the mean decrease in pain was greater in the bupivacaine 0.5% group by 0.30 points 5.10 minutes after injection (95% CI, -0.03 to 0.63 points; p = 0.08) and 0.46 points 1 week after injection (95% CI, 0.13.0.77 points; p = 0.01). CONCLUSION: Both bupivacaine 0.5% and bupivacaine 0.25% provide statistically significant and much improved pain relief 5.10 minutes and 1 week after intraarticular glenohumeral injections. Bupivacaine 0.5% provided greater pain relief than bupivacaine 0.25%, but the difference was less than 0.5 points and therefore did not meet the MCID threshold.
AB - OBJECTIVE: Mixtures of local anesthetics and steroids are routinely injected intraarticularly to temporarily relieve joint pain, even though local anesthetics have been reported to cause chondrocyte death in a dose- and time-dependent manner. This study aimed to determine if intraarticular injections of bupivacaine 0.5% and bupivacaine 0.25% would provide similar pain relief. MATERIALS AND METHODS: All fluoroscopically guided glenohumeral joint injections performed using 2.5 mL of bupivacaine and 0.5 mL (20 mg) of triamcinolone acetonide over a 42-month period were included if a pain score was recorded before, 5.10 minutes after, and 1 week after injection. Pain reduction of more than 2 points was considered much improved clinically with pain reduction of more than 1 point considered the minimum clinically important difference (MCID) threshold. RESULTS: Statistically significant and much improved pain reduction was achieved using both bupivacaine 0.5% and 0.25% 5.10 minutes (-3.7 points; 95% CI, -3.4 to -4.0 points; p ≤ 0.001; and.3.3 points; 95% CI, -3.0 to -3.5 points; p ≤ 0.001) and 1 week (-2.5 points; 95% CI, -2.2 to -2.9 points; p ≤ 0.001; and -2.1 points; 95% CI, -1.8 to -2.3 points; p ≤ 0.001) after injection, respectively. Adjusting for age, sex, pain score before injection, and indication, the mean decrease in pain was greater in the bupivacaine 0.5% group by 0.30 points 5.10 minutes after injection (95% CI, -0.03 to 0.63 points; p = 0.08) and 0.46 points 1 week after injection (95% CI, 0.13.0.77 points; p = 0.01). CONCLUSION: Both bupivacaine 0.5% and bupivacaine 0.25% provide statistically significant and much improved pain relief 5.10 minutes and 1 week after intraarticular glenohumeral injections. Bupivacaine 0.5% provided greater pain relief than bupivacaine 0.25%, but the difference was less than 0.5 points and therefore did not meet the MCID threshold.
KW - Bupivacaine
KW - Intraarticular injections
KW - Local anesthetics
KW - Pain
KW - Shoulder joint
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U2 - 10.2214/AJR.15.15132
DO - 10.2214/AJR.15.15132
M3 - Article
VL - 206
SP - 805
EP - 809
JO - American Journal of Roentgenology
JF - American Journal of Roentgenology
SN - 0361-803X
IS - 4
ER -