Does Low-does Cervical Epidural Lidocaine Cause Transient Weakness?

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 in the recovery phase after the injection
procedure.

Additionally, investigation of short-term pain, function, medication use, and global
impression of change following use of local anesthetic versus saline as a diluent during
interlaminar cervical ESI will provide evidence to inform the optimization of clinical
outcomes related to steroid diluent choice.

Inclusion Criteria:

1. Age 18-80.

2. Clinical diagnosis of cervical radicular pain.

3. Magnetic resonance imaging pathology consistent with clinical symptoms/signs.

4. Numerical Rating Scale (NRS) pain score of 4 or higher.

5. Pain duration of more than 6 weeks despite trial of conservative therapy (medications,
physical therapy, or chiropractic care).

6. Patients who will undergo CESI for treatment of cervical radiculitis.

Exclusion Criteria:

1. Refusal to participate, provide consent, or provide communication and follow-up
information for duration of the study.

2. Inability to perform handgrip or arm strength testing.

3. Contraindications to Cervical ESI (active infection, bleeding disorders, current
anticoagulant or antiplatelet medication use, allergy to medications used for CIESI,
and pregnancy).

4. Current glucocorticoid use or ESI within past 6 months.

5. Prior cervical spine surgery.

6. Cervical spinal cord lesions; cerebrovascular, demyelinating, or other neuro-muscular
muscular disease.

7. Patient request for or requirement of conscious sedation for the injection procedure.