Keywords:
Musculoskeletal joint, Extremities, Musculoskeletal system, Fluoroscopy, Percutaneous, Comparative studies, Equipment, Efficacy studies, Toxicity, Drugs / Reactions, Outcomes
Authors:
M. R. F. Jaring1, L. Duerden1, S. E. Davies1, G. CHATZAKIS2, S. James2, F. Jewell2, C. Pawley2; 1Bristol/UK, 2Gloucester/UK
DOI:
10.26044/ecr2019/C-1769
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 differences in pain between groups receiving intraarticular anaesthetic or saline,
these differences are extremely small.
For example,
in our only significant result (at 15 minutes) the variation in scores was 0.3.
To put this number in to perspective,
given that patients are being asked to rate a visual scale from 0-10 this is a 3% variation in pain overall.
When it comes to assessing cost saving,
this 3% benefit equated to using levobupivacaine (£1.50 per patient) rather than normal saline (£0.30 per patient).
The usefulness of intraarticular anaesthesia is further brought into question when the difference between our saline and levobupivacaine groups are compared with reference to the minimum ‘clinically important difference’.
This is the change in rating (using either a visual or numerical analogue scale) required to reflect clinically useful improvements in pain.
Studies in anaesthetics have suggested that a 1.5-2.0 difference is required for this (none of our results approached this) [7].
Another study of chronic musculoskeletal pain found that clinically importance varied depending on the patients’ baseline pain,
and overall a score of -2.0 was required to equate to the pain being described as “much better” [8].
There were limitations to our study,
including that the limited response rate may favour those who experienced discomfort and therefore had a greater desire to return the chart.
The total numbers were also towards the lower end of the spectrum compared to other studies.
In conclusion,
our study assesses the current evidence regarding the benefits of intraarticular anaesthesia during arthrography,
as well as contrasting this with the growing concern regarding the potential chondrotoxicity.
It should be noted that studies on chondrotoxicity were all in vitro assessments and no long-term studies have been undertaken.
Despite a statistically significant change in pain at 15 minutes,
these results were unlikely to be clinically significant.
Given this,
radiologists must consider whether the possibility of minor short-term benefits in pain management outweigh emerging concerns regarding chondrotoxicity.