Water-diluted local anesthetic for trigger-point injection in chronic myofascial pain syndrome: Evaluation of types of local anesthetic and concentrations in water

Iwama, Hiroshi; Ohmori, Satoshi; Kaneko, Toshikazu; Watanabe, Kazuhiro

doi:10.1053/rapm.2001.24672

Cited by 21 publications

(25 citation statements)

References 11 publications

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“…Although it can have severe consequences, 19 it has not generated much clinical concern. In fact, intramuscular local anesthetic injection is a standard treatment for trigger points in myofascial pain syndromes, 28 and local anesthetic myotoxicity is generally reversible. The distinction that must be made, however, is that those treatments generally involve a single-shot drug injection with a brief duration, whereas microparticulate systems can result in very high local concentrations and/or weeks of local anesthetic exposure.…”

Section: Discussionmentioning

confidence: 99%

Local Myotoxicity from Sustained Release of Bupivacaine from Microparticles

et al. 2008

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Background: Sustained release of local anesthetics is frequently associated with myotoxicity. The authors investigated the role of particulate delivery systems and of the pattern of drug release in causing myotoxicity.Methods: Rats were given sciatic nerve blocks with bupivacaine solutions, two types of bupivacaine-containing microparticles (polymeric microspheres and lipid-protein-sugar particles), or blank particles with or without bupivacaine in the carrier fluid. Myotoxicity was scored in histologic sections of the injection sites. Bupivacaine release kinetics from the particles were measured. Myotoxicity of a range of bupivacaine concentrations from exposures up to 3 weeks was assessed in C2C12 myotubes, with or without microparticles.Results: Both types of bupivacaine-loaded microparticles, but not blank particles, were associated with myotoxicity. Whereas 0.5% bupivacaine solution caused little myotoxicity, a concentration of bupivacaine that mimicked the amount of bupivacaine released initially from particles caused myotoxicity. Local anesthetics showed both concentration and time-dependent myotoxicity in C2C12s. Importantly, even very low concentrations that were nontoxic over brief exposures became highly toxic after days or weeks of exposure. The presence of particles did not increase bupivacaine myotoxicity in vitro but did in vivo. Findings applied to both particle types.Conclusions: Whereas the release vehicles themselves were not myotoxic, both burst and extended release of bupivacaine were. A possible implication of the latter finding is that myotoxicity is an inevitable concomitant of sustained release of local anesthetics. Particles, and perhaps other vehicles, may enhance local toxicity through indirect mechanisms.

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Section: Discussionmentioning

confidence: 99%

Local Myotoxicity from Sustained Release of Bupivacaine from Microparticles

et al. 2008

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“…Lidocaine is an acceptable alternative, although standard 1% lidocaine may be less painful and better tolerated if diluted to 0.25% concentration [31]. The longer-acting agent bupivacaine is not recommended because it can be quite myotoxic [32] and is more painful than lidocaine [33].…”

Section: Trigger Point Injectionmentioning

confidence: 99%

Evaluation of treatments for myofascial pain syndrome and fibromyalgia

Rudin

2003

Current Science Inc

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Myofascial pain syndrome (MPS) and fibromyalgia (FM) are complex conditions and pose significant challenges to clinicians and patients. This chapter explores available treatments for MPS and FM in the context of pathophysiology, clinical evidence, and experimental support. This information may prove to be helpful in designing individualized treatment for patients with these complex syndromes. New treatments should be critically and carefully evaluated as they appear.

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“…18,19 This study recorded whether subjects had clinical insomnia, along with the ISI score. We then checked for MTrPs on the gastrocnemius muscles and injected 1 to 2 mL of 0.25% lidocaine into each of the TrPs 14,20 ( Figure 1C). One week later (T1), if the patients came to the hospital, we again recorded the NRS pain score, FC, and the ISI score; rechecked MTrPs; and repeated TrP injection only in cases in which MTrPs existed.…”

Section: Methodsmentioning

confidence: 99%

The Effects of Myofascial Trigger Point Injections on Nocturnal Calf Cramps

Kim

Yoon

2015

The Journal of the American Board of Family Medicine

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Background: The purpose of this study was to elucidate the effects of injection at trigger points on pain and sleep disturbance in patients with nocturnal calf cramps (NCCs).Methods: Patients with NCCs that occurred at least once per week and who had myofascial trigger points (MTrPs) on the gastrocnemius muscles were enrolled in the study for 9 months. At the first visit (T0), we measured the intensity of NCC pain on an 11-point numeric rating scale, recorded the frequency of NCCs, and calculated the Insomnia Severity Index (ISI). We then checked for MTrPs on the gastrocnemius muscles and injected 1-2 mL of 0.25% lidocaine into each of the trigger points. At 1 (T1), 2 (T2), and 4 (T3) weeks after the first visit, we repeated the process performed at T0.Results: Twelve patients completed the treatment schedule and attended the follow-up visits. Mean values of the numeric rating scale pain score, frequency of cramps, and ISI declined significantly at T1, T2, and T3 compared with baseline (all P < .01). Of 12 patients, 10 had clinical insomnia before treatment, and this number decreased significantly to 3 patients at T2 and 1 patient at T3 (P ‫؍‬ .012 and P ‫؍‬ .001, respectively).Conclusions: These preliminary data show that injection at MTrPs in patients with NCCs not only alleviated pain and reduced the frequency of cramps but also lessened the severity of insomnia as measured by the ISI. A larger randomized controlled trial is needed to confirm these findings and determine whether the effect lasts over the long term. (J Am Board Fam Med 2015;28:21-27.)

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Water-diluted local anesthetic for trigger-point injection in chronic myofascial pain syndrome: Evaluation of types of local anesthetic and concentrations in water

Abstract: The suitable type of local anesthetic may be lidocaine or mepivacaine, and the most effective water-diluted concentration is considered to be 0.2% to 0.25%.

Cited by 21 publications

References 11 publications

Local Myotoxicity from Sustained Release of Bupivacaine from Microparticles

Local Myotoxicity from Sustained Release of Bupivacaine from Microparticles

Evaluation of treatments for myofascial pain syndrome and fibromyalgia

The Effects of Myofascial Trigger Point Injections on Nocturnal Calf Cramps

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