Aims and objectives
Post-arthrography pain isa well documented side effect of the intraarticular injection of contrast media,
generally prior to computed tomography (CT) or,
Magnetic resonance imaging (MRI).
Studies have shown this pain is both predictable and significant,
leading to the recommendationpatients should be made aware of post-procedure discomfort during the consent process [1].
The process of arthrography will generally involve the fluoroscopically (or more rarely ultrasound) guided insertion of a needle into a joint.
If required position can be confirmed with iodinated contrast and following this the...
Methods and materials
Of the four musculoskeletal radiologists at our institution,
two have historically used intraarticular levobupivacaine (CP/GC) and two have not,
instead choosing to use normal saline as a medium in which to dilute gadolinium for intraarticular injection (FJ/SJ).
The arthrographic procedure is otherwise very similar.
When performing arthrography,
both groups would prepare a 1/200 dilution of gadolinium using a 20ml syringe.
10ml of this syringe would include iodinated contrast and 10ml would include either normal saline or 0.25% levobupivacaine.
Depending on the joint involved varying amounts...
Results
45 pains diaries were returned completed during the 5 months of data collection (return rate approaching 50%).
Of these 27 were from the levobupivacaine group and 18 were in the saline group.
There was an even mix of shoulder and hip joints between the two groups,
however the levobupivicaine group contained more wrists,
and the saline group contained the only knee ( Table 1 ).
When compared to the patient’s baseline pain scores,
at 15 minutes there was a modest reduction in overall pain in...
Conclusion
Our study provides further insight into the usefulness of intraarticular anaesthesia in in managing post-arthrography pain.
Unlike some previous studies which found significant relief in both acute and delayed pain,
our study found that the only significant difference was at 15 minutes.
Beyond this any variation between the saline and anaesthetic groups were not significant.
As was seen in previous studies we showed that post arthrography pain peaked at between 4 and 24 hours.
Past studies have highlighted the fact that despite finding statistically significant...
References
1. Saupe N,
Zanetti M,
Pfirrmann CW,
Wels T,
Schwenke C,
Hodler J.
Pain and other side effects after MR arthrography: prospective evaluation in 1085 patients.
Radiology.
2009 Mar;250(3):830-8
2.Mosimann PJ,
Richarme D,
Becce F,
Knoepfli AS,
Mino V,
Meuli R,
Theumann N.
Usefulness of intra-articular bupivacain and lidocain adjunction in MR or CT arthrography: A prospective study in 148 patients.
European journal of radiology.
2012 Sep 1;81(9):e957-61.
3.Fox MG,
Petrey WB,
Alford B,
Huynh BH,
Patrie JT,
Anderson MW.
Shoulder MR arthrography: intraarticular anesthetic...