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Trial record 3 of 119 for:    "Neuromuscular Disease" | "Lidocaine"

Do Cervical Interlaminar Epidural Steroid Injections With Low-dose Lidocaine Cause Transient Objective Upper Extremity Weakness? A Prospective Randomized Controlled Trial

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ClinicalTrials.gov Identifier: NCT03127137
Recruitment Status : Recruiting
First Posted : April 25, 2017
Last Update Posted : June 4, 2019
Sponsor:
Information provided by (Responsible Party):
David Walega, Northwestern University

Brief Summary:

Cervical radicular pain is relatively common, often treated with epidural steroid injection (ESI), when conservative treatments like oral analgesics, physical therapy and activity modification have failed. There are no universal clinical practice guidelines for the use of diluents when CESI are performed.

Interlaminar CESI may be performed with or without the use of local anesthetics, due to training bias or theoretical concerns of weakness. CESI without the benefit of local anesthetic as a steroid diluent increases the latency of pain relief and may decrease diagnostic information immediately after a CESI with regard to pain generators responsible for symptoms, and may potentially decrease patient satisfaction.

By evaluating the effects of local anesthetic as a diluent during interlaminar cervical ESI, we will enhance the safety of this treatment with regard to expectations of objective motor weakness as well as post procedure pain control and patient satisfaction in the recovery phase after the injection procedure.

Research Question:

Does lidocaine versus saline as a steroid diluent effect objective upper extremity strength following cervical epidural steroid injection in patients being treated for cervical radiculitis?

Null Hypothesis:

Cervical epidural steroid injections that include local anesthetic as a diluent have no effect on objective upper extremity strength following the injection.

We hypothesized that cervical epidural lidocaine will cause an objective decrease in strength in functional movements of the upper extremity.


Condition or disease Intervention/treatment Phase
Cervical Radiculitis Pain Other: Control cohort group Drug: Experimental Group 1 triamcinolone and lidocaine Drug: Experimental Group 2 triamcinolone and saline Phase 4

Detailed Description:

Control Group: Prospective observational cohort study of UE strength in pain clinic patients undergoing trigger point injections and occipital nerve injections to serve as controls to measure variability of strength testing before and 30 min after such an intervention.

Experimental Groups: Prospective, randomized, controlled, double blinded trial in patients undergoing CESI for symptoms of cervical radiculitis.

Group #1: Interlaminar cervical ESI at the C7-T1 level with triamcinolone 80 mg + 2 mL 1% lidocaine (total volume 4 cc).

Group #2: Interlaminar cervical ESI at the C7-T1 level with triamcinolone 80 mg + 2 mL preservative saline (total volume 4 cc).

Adults who are eligible to have a CESI with triamcinolone for treatment of cervical radiculitis at the Northwestern Anesthesiology Pain Medicine Center will be approached by authorized research personnel prior to a patient's CESI is performed and will obtain informed consent from patients who agree to participate.

In every subject (Control Cohort, Group 1 and Group 2) a pre-procedure NRS pain score, and presence of subjective or objective symptoms of UE weakness will be recorded. Bilateral handgrip, wrist extension, elbow flexion, and elbow extension strength (myotomes C5-T1) will be measured by a trained research assistant prior to the injection procedure using a handheld JAMAR® PLUS+ digital dynamometer (Sammons Preston, Bollingbrook, IL) for hand grip strength and a push/pull handheld hydraulic dynamometer (Balego and Associates Inc., St. Paul, MN) for arm strength assessment. Three baseline strength measurements will be recorded for each strength test. Measurements will be taken prior to and 30 minutes following the injection procedure. Patients in Group #1 and Group #2 will also be queried with the Upper Extremity Functional Index (UEFI) before the injection procedure and again 1 day after the procedure (administered via telephone).

For Group 1 and Group 2, patients will be randomized to treatment group based on a random computer-generated schedule. Participants will be blinded to the group to which they are randomized. All standard procedures for CESIs will be followed as is standard practice including time out, skin prep, hemodynamic monitoring, image guidance etc.

Per randomization, triamcinolone acetonide 80 mg (Kenalog) (E. R. Squibb & Sons Limited, Uxbridge UK) will be combined with 2mL Lidocaine 1% or 2 mL preservative free saline and will be injected during the CESI procedure. In all cases, the total injectate volume will be 4 mL in all cases. All injections will be image guided with fluoroscopy, as is the current standard practice. Fluoroscopy time will be recorded.

The participant will be discharged from the clinic with written discharge instructions (current standard practice).

Participants will be telephoned by clinic personnel 1 day after the CESI to assess for subjective weakness in the hands or arms as well as any other adverse reactions. As above, the Upper Extremity Functional Index will be administered at this time.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 140 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Prospective Randomized Controlled Trial using control arm plus 2 arm experimental (placebo and active drug)
Masking: Double (Participant, Outcomes Assessor)
Masking Description: Participant will be blinded to group assignment. Outcome assessor will also be blinded to the randomization.
Primary Purpose: Treatment
Official Title: Do Cervical Interlaminar Epidural Steroid Injections With Low-dose Lidocaine Cause Transient Objective Upper Extremity Weakness? A Prospective Randomized Controlled Trial
Actual Study Start Date : August 1, 2018
Estimated Primary Completion Date : December 31, 2021
Estimated Study Completion Date : January 15, 2022

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Control cohort Group
Control cohort group will receive medications not predetermined by the set protocol.
Other: Control cohort group
Control cohort group will receive medications not predetermined by the set protocol.

Active Comparator: Experimental Group 1
Experimental Group 1 will receive Interlaminar cervical ESI at the C7-T1 level with triamcinolone 80 mg + 2 mL 1% lidocaine (total volume 4 cc)
Drug: Experimental Group 1 triamcinolone and lidocaine
Experimental Group 1 will receive Interlaminar cervical ESI at the C7-T1 level with triamcinolone 80 mg + 2 mL 1% lidocaine (total volume 4 cc)
Other Name: Experimental Group 1

Placebo Comparator: Experimental Group 2
Interlaminar cervical ESI at the C7-T1 level with triamcinolone 80 mg + 2 mL preservative saline (total volume 4 cc)
Drug: Experimental Group 2 triamcinolone and saline
Interlaminar cervical ESI at the C7-T1 level with triamcinolone 80 mg + 2 mL preservative saline (total volume 4 cc)
Other Name: Experimental Group 2




Primary Outcome Measures :
  1. Change in strength for each individual in each treatment group before and 30 minutes after CESI [ Time Frame: Baseline and 30 minutes after the CESI procedure ]
    Change in strength for each individual in each treatment group before and 30 minutes after CESI using hand held Dynamometer


Secondary Outcome Measures :
  1. Change in mean arterial pressure [ Time Frame: Baselind and 30 minutes after CESI procedure ]
    Change in mean arterial pressure prior to and 30 minutes after CESI, via automated blood pressure cuff measure.

  2. Change in heart rate [ Time Frame: Baseline and 30 minutes after CESI ]
    Change in heart rate prior to and 30 minutes after CESI

  3. Pain Scores [ Time Frame: Baseline and 30 minutes after CESI ]
    Change in average pain score before and after CESI

  4. UEFI score change [ Time Frame: Baseline and 30 minutes after CESI ]
    Change is UEFI (Upper Extremity Functional Index) scores before and after CESI

  5. Complication rate [ Time Frame: Baseline and 24 hours after CESI procedure ]
    Procedure complications or adverse reactions to medications used



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • All patients ages 18 years or older who will undergo CESI for treatment of cervical radiculitis

Exclusion Criteria:

  • Patient refusal
  • Lack of consent
  • Any contraindication to CESI
  • Inability to communicate with staff or to participate in follow up
  • Inability to perform handgrip or arm strength testing
  • Cervical spinal cord lesions
  • Cerebrovascular, demyelinating or other neuromuscular muscular disease
  • Patient request for or requirement of conscious sedation for the injection procedure
  • Pregnancy
  • Breast feeding
  • Sensitivity to amides
  • History of allergy to local anesthetics

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03127137


Contacts
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Contact: David Walega, M.D. 312-695-4052 d-walega@northwestern.edu

Locations
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United States, Illinois
Northwestern Memorial Hospital Recruiting
Chicago, Illinois, United States, 60611
Contact: David Walega, M.D.    312-695-4052    d-walega@northwestern.edu   
Sponsors and Collaborators
Northwestern University
Investigators
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Principal Investigator: David Walega, M.D. Northwestern University

Publications:
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Responsible Party: David Walega, Principal Investigator, Northwestern University
ClinicalTrials.gov Identifier: NCT03127137     History of Changes
Other Study ID Numbers: STU00204980
First Posted: April 25, 2017    Key Record Dates
Last Update Posted: June 4, 2019
Last Verified: June 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Additional relevant MeSH terms:
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Neuromuscular Diseases
Lidocaine
Radiculopathy
Peripheral Nervous System Diseases
Nervous System Diseases
Triamcinolone
Triamcinolone Acetonide
Triamcinolone hexacetonide
Triamcinolone diacetate
Anesthetics, Local
Anesthetics
Central Nervous System Depressants
Physiological Effects of Drugs
Sensory System Agents
Peripheral Nervous System Agents
Anti-Arrhythmia Agents
Voltage-Gated Sodium Channel Blockers
Sodium Channel Blockers
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Anti-Inflammatory Agents
Glucocorticoids
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Immunosuppressive Agents
Immunologic Factors
Enzyme Inhibitors