Lidocaine may reduce pain at time of corticosteroid injection for hand, wrist conditions
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Key takeaways:
- Lidocaine may reduce pain during corticosteroid injection in hand and wrist conditions.
- Bayesian statistical models may reduce cost, energy, time and number of patients needed to enroll for clinical trials.
Patients who received lidocaine at the time of corticosteroid injection for hand and wrist conditions experienced lower pain intensity compared with those who did not receive lidocaine, according to presented results.
“There is literature that shows that, in small joints of the hand and wrist, the anesthetic lidocaine may not reduce pain intensity during corticosteroid injection possibly because of the added volume in those small joints causing more discomfort,” George E. Sayegh, BS, a first-year medical student at the Long School of Medicine at the University of Texas Health San Antonio, told Healio about results presented at the top-10 papers session at the American Society for Surgery of the Hand Annual Meeting.
He continued, “What we found was that 0.5cc lidocaine does reduce patient-reported pain intensity using Numeric Rating Scale-11 at the time of corticosteroid injection and at 5 minutes after and 4 hours after. The anesthetic effect was ultimately shown to be more effective than any discomfort resulting from the increase in volume, even in those small joints.”
Reduction in pain
Using Bayesian statistical trial methods, Sayegh and colleagues from the department of orthopedics at Dell Medical School at UT Austin randomly assigned 39 patients with trapeziometacarpal joint arthritis, trigger finger or de Quervain tendinopathy to receive a corticosteroid injection (triamcinolone 0.5cc) either with or without lidocaine. According to the study, published in The Journal of Hand Surgery – European Volume, the researchers analyzed pain intensity during the corticosteroid injection and at 5 minutes and at 4 hours after the injection.
Sayegh said patients in the lidocaine group experienced a significant reduction in pain intensity during corticosteroid injection. Although results also showed a reduction in pain at both 5 minutes and 4 hours after injection, Sayegh said lidocaine was “most efficacious at the time of injection to reduce pain.”
Bayesian statistical model
Sayegh said the study was designed using Bayesian statistical trial methods, which uses extracted data from each enrolled patient to produce “Markov chain Monte Carlo” simulations, while evaluating when the target probability has been achieved. According to Sayegh, use of a Bayesian statistical model may reduce “cost, energy, time and patients needed to enroll for studies.”
“The most important thing is using high quality parameters for the target probability (a priori probability), running many quality simulations after each new entry of data and having a statistician familiar with these trial methods on hand to help run the analysis properly,” Sayegh said.
He added, “I believe the Bayesian trial method is going to be utilized much more in orthopedic clinical trials, but we need more structure and guidelines around how it is used so we make sure that we are producing accurate and consistent data and [that] we are not creating other problems for ourselves by being inconsistent with it across the board.”
Reference:
Teunis T, et al. J Hand Surg Eur Vol. 2024;doi:10.1177/17531934241245036.
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Teunis T, et al. Paper 9. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 19-21, 2024; Minneapolis.
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