Korean J Pain.  2011 Jun;24(2):74-80. 10.3344/kjp.2011.24.2.74.

Use of Lidocaine Patch for Percutaneous Endoscopic Lumbar Discectomy

• Kim KH

• KMID: 2074001
• DOI: http://doi.org/10.3344/kjp.2011.24.2.74

Abstract

BACKGROUND
Lidocaine patch (L5P) has demonstrated short-term efficacy in treating both acute surgical pain and chronic neuropathic pain with tolerable side effects. Percutaneous endoscopic lumbar discectomy (PELD) is the mainstay of minimally invasive spine surgery (MISS). Sufficient analgesia during PELD surgery makes the patient consider it real MISS. This study was performed to evaluate the efficacy and adverse effects of lidocaine patch in patients who underwent PELD under local anesthesia.
METHODS
L5P (L group) or placebo (P group) was randomly applied on the skin of the back covering the anticipated path of the working channel before 1 hour of surgery in 100 patients who underwent a single level PELD at L4-L5. Efficacy of the lidocaine patch was assessed by patient's numeric rating scale (NRS) of pain at each stage during the surgery and by a 5-scale grading of the satisfaction with the anesthesia of the operator and patients after surgery.
RESULTS
Mean NRS scores at the stages of needle insertion, skin incision, serial dilation and insertion of working channel, and subcutaneous suture were significantly lower in the L group than the P group. Postoperative operator's and patients' satisfaction scores were also significantly higher in L group than in the P group. There were subtle adverse effects in both groups.
CONCLUSIONS
L5P provided better pain relief during PELD, especially at the stage of needle insertion, skin incision, serial dilation and insertion of working channel, and subcutaneous suture. It also provided higher patient and operator postoperative satisfaction, with only subtle adverse effects.

Keyword

analgesia; endoscopy; lidocaine; percutaneous discectomy; transdermal patch

MeSH Terms

Analgesia
Anesthesia
Diskectomy
Diskectomy, Percutaneous
Endoscopy
Humans
Lidocaine
Needles
Neuralgia
Skin
Spine
Sutures
Transdermal Patch
Lidocaine

Figure

• 

  Fig. 1 The anticipated passage of the needle and working channel while performing percutaneous endoscopic lumbar discectomy at the L4-L5. The anatomic structures from the skin to the targeted anulus at the L4-L5 intervertebral disc space are seen in the following order from the skin surface to the disc: (1) the latissimus dorsi muscle, (2) external and internal oblique muscle, (3) superficial thoracolumbar fascia, (4) erector spinae muscle (lateral tract: iliocostalis lumborum muscle), (5) deep thoracolumbar fascia, (6) quadratus lumborum muscle, (7) erector spinae muscle (lateral tract: intertransversarii mediales muscle), and (8) psoas major muscle. This is a case of a 37-year-old patient who underwent single-level PELD at the L4-L5. (A) Preoperative T2-weighted sagittal magnetic resonance image (MRI); the approaching angle and distance from the midline were measured for the proper placement of the needle and working channel before PELD (B); preoperative T2-weighted axial MRI; (C) intraoperative discogram, lateral view; and (D) postoperative computed tomography. Air shadows are seen in the passage of the working channel in the muscles (arrow) and in the anterior epidural space after the removal of herniated nucleus pulposus using right-angled forceps (circle).

Reference

1. Rowbotham MC, Davies PS, Verkempinck C, Galer BS. Lidocaine patch: double-blind controlled study of a new treatment method for post-herpetic neuralgia. Pain. 1996; 65:39–44. PMID: 8826488.

2. Moon JY, Choi JB, Lee PB, Son HM, Nam FS, Kim YC, et al. An open-label trial of the 5% lidocaine patches for the treatment of chronic pain. Korean J Pain. 2009; 22:216–223.

3. Curry SE, Finkel JC. Use of the Synera patch for local anesthesia before vascular access procedures: a randomized, double-blind, placebo-controlled study. Pain Med. 2007; 8:497–502. PMID: 17716323.

4. Schecter AK, Pariser DM, Pariser RJ, Ling MR, Stewart D, Sadick NS. Randomized, double-blind, placebo-controlled study evaluating the lidocaine/tetracaine patch for induction of local anesthesia prior to minor dermatologic procedures in geriatric patients. Dermatol Surg. 2005; 31:287–291. PMID: 15841628.

5. Tsou PM, Alan Yeung C, Yeung AT. Posterolateral transforaminal selective endoscopic discectomy and thermal annuloplasty for chronic lumbar discogenic pain: a minimal access visualized intradiscal surgical procedure. Spine J. 2004; 4:564–573. PMID: 15363430.

6. Kim KH. Posterolateral percutaneous endoscopic lumbar discectomy. Korean J Pain. 2004; 17(Suppl):5–12.

7. Moeller TB, Reif E. Pocket atlas of sectional anatomy. Volume 3 spine, extremities, joints. 2007. Stuttgart: Thieme;p. 310–311.

8. Ross LM, Lamperti ED. Atlas of anatomy. General anatomy and musculoskeletal system. 2006. Stuttgart: Thieme;p. 138–141.

9. Freeman R. The treatment of neuropathic pain. CNS Spectr. 2005; 10:698–706. PMID: 16142210.

10. Kern KU, Kohl M, Kiefer RT. Lidocaine patch for therapy of neuropathic and non-neuropathic pain. A clinical case series of 87 patients. Nervenarzt. 2010; 81:1490–1497. PMID: 20577706.

11. Kanai A, Suzuki A, Okamoto H. Comparison of cutaneous anesthetic effect of 8% lidocaine spray with lidocaine patch using current perception threshold test. Pain Med. 2010; 11:472–475. PMID: 20113414.

12. Lavand'homme P. Perioperative pain. Curr Opin Anaesthesiol. 2006; 19:556–561. PMID: 16960491.