Are local analgesics effective in reducing autonomic dysreflexia in individuals with spinal cord injury? A systematic review

Katherine Gray; Whitley Sheehan; Laura McCracken; Klaus Krogh; Rahul Sachdeva; Andrei V. Krassioukov

doi:10.1038/s41393-022-00840-8

Are local analgesics effective in reducing autonomic dysreflexia in individuals with spinal cord injury? A systematic review

Katherine Gray, Whitley Sheehan, Laura McCracken, Klaus Krogh, Rahul Sachdeva, Andrei V. Krassioukov

Rehabilitation Medicine

Research output: Contribution to journal › Review article › peer-review

Abstract

Study design: Systematic review. Objectives: To systematically review the evidence on the use of local analgesics, specifically lidocaine or bupivacaine, to prevent autonomic dysreflexia (AD) during iatrogenic procedures or bowel and bladder care routines in individuals with spinal cord injury (SCI). Methods: A keyword search of MEDLINE, CINAHL, CENTRAL, Cochrane Reviews, PsycInfo, Embase, and Web of Science databases identified all English-language studies evaluating the efficacy of local analgesics in reducing AD. Included studies were either randomized controlled trials (RCTs) or quasi-experimental studies. Participants were adults with chronic SCI who received local analgesics prior to AD-triggering procedures or routines. Additionally, studies were required to report blood pressure values as an outcome. The methodology of this review followed the PRISMA checklist and was registered with PROSPERO (CRD42021219506). Results: Four RCTs and two quasi-experimental studies met inclusion criteria. Results were narratively synthesized as meta-analysis was not possible due to heterogeneity across studies included in the review. All six studies administered lidocaine. Lidocaine was found to have a beneficial effect on AD in three studies, no effect in two studies and a detrimental effect in one study. Conclusions: Presently, RCTs and quasi-experimental studies on the use of lidocaine for reducing AD in individuals with SCI had small sample sizes and opposing findings. There is a strong need for definitive, well-monitored clinical trials with adequate sample sizes. Presently there is not enough compelling evidence to support or refute recommendations for the use of lidocaine from the AD management clinical practice guidelines.

Original language	English
Pages (from-to)	1-7
Number of pages	7
Journal	Spinal Cord
Volume	61
Issue number	1
DOIs	https://doi.org/10.1038/s41393-022-00840-8
State	Published - Jan 2023

Bibliographical note

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to International Spinal Cord Society.

Funding

We thank Dr. Trina Fyfe, the Health Sciences Librarian for the Northern Medical Program at UBC, for the theoretical and conceptual assistance during the database search process. Dr. Krassioukov\u2019s laboratory is supported by funds from the Canadian Institute for Health Research, Heart and Stroke Foundation, Canadian Foundation for Innovation, BC Knowledge Development Fund, PRAXIS Spinal Institute, Wings for Life Spinal Cord Research Foundation, International Spinal Research trust (ISRT), Craig H. Neilsen Foundation; and Seed grants from International Collaboration on Repair Discoveries (ICORD). Dr. Krassioukov holds Endowed Chair in Spinal Cord Rehabilitation Research, Department of Medicine, UBC. Dr. Sachdeva is supported by the Wings for Life Spinal Cord Research Foundation and has fellowships from Canadian Institutes of Health Research, Michael Smith Foundation for Health Research (MSFHR), and Faculty of Medicine, University of British Columbia (Bluma Tischler Fellowship). Dr. Krogh is supported by the Novonordisk Foundation.

Funders	Funder number
Faculty of Medicine, University of British Columbia
Michael Smith Foundation for Health Research
Department of Medicine, University of California, San Francisco
Canadian Institute for Health Research, Heart and Stroke Foundation
Craig H. Neilsen Foundation
Univ. of Northern British Columbia
Wings for Life Spinal Cord Research Foundation
Canadian Institutes of Health Research
Novo Nordisk Fonden
International Spinal Research Trust

ASJC Scopus subject areas

Rehabilitation
Neurology
Clinical Neurology

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10.1038/s41393-022-00840-8

Cite this

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abstract = "Study design: Systematic review. Objectives: To systematically review the evidence on the use of local analgesics, specifically lidocaine or bupivacaine, to prevent autonomic dysreflexia (AD) during iatrogenic procedures or bowel and bladder care routines in individuals with spinal cord injury (SCI). Methods: A keyword search of MEDLINE, CINAHL, CENTRAL, Cochrane Reviews, PsycInfo, Embase, and Web of Science databases identified all English-language studies evaluating the efficacy of local analgesics in reducing AD. Included studies were either randomized controlled trials (RCTs) or quasi-experimental studies. Participants were adults with chronic SCI who received local analgesics prior to AD-triggering procedures or routines. Additionally, studies were required to report blood pressure values as an outcome. The methodology of this review followed the PRISMA checklist and was registered with PROSPERO (CRD42021219506). Results: Four RCTs and two quasi-experimental studies met inclusion criteria. Results were narratively synthesized as meta-analysis was not possible due to heterogeneity across studies included in the review. All six studies administered lidocaine. Lidocaine was found to have a beneficial effect on AD in three studies, no effect in two studies and a detrimental effect in one study. Conclusions: Presently, RCTs and quasi-experimental studies on the use of lidocaine for reducing AD in individuals with SCI had small sample sizes and opposing findings. There is a strong need for definitive, well-monitored clinical trials with adequate sample sizes. Presently there is not enough compelling evidence to support or refute recommendations for the use of lidocaine from the AD management clinical practice guidelines.",

author = "Katherine Gray and Whitley Sheehan and Laura McCracken and Klaus Krogh and Rahul Sachdeva and Krassioukov, \{Andrei V.\}",

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Are local analgesics effective in reducing autonomic dysreflexia in individuals with spinal cord injury? A systematic review

Abstract

Bibliographical note

Funding

ASJC Scopus subject areas

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