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
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 would be injected (for example larger volumes (10-15ml) were injected into the hip or shoulder,
when compared to the wrist (3-5ml)).
The absence of a strict quantity is seen in previous studies,
where radiologists will describe instead injecting until the joint appears and ‘feels’ full.
We designed a prospective study as part of a quality improvement study at Gloucester Royal Hospital between October 2017 and March 2018.
Standardised post procedure pain diaries were distributed to all patients undergoing arthrography prior to MRI or CT,
of any joint.
The pain diary asked patients to score their pain using a validated numerical rating scale (example on table 2) at baseline,
4 hours,
24 hours and 7 days.
Return envelopes were provided to the patients.
Patients were allocated randomly to one of the four musculoskeletal radiologist's fluoroscopy lists by booking staff,
who were not aware of the variations in procedure.
Returned pain diaries were collated and separated into either normal saline or levobupivacaine groups.
Means for each group’s pain scores were then calculated and there groups were then compared using a t-test.