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).
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).
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.
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.
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Teasell RW, Mehta S, Aubut JL, Foulon B, Wolfe DL, Hsieh JTC, et al. A systematic review of pharmacologic treatments of pain after spinal cord injury. Arch Phys Med Rehabil. 2010;91:816–31.
Sachdeva R, Nightingale TE, Krassioukov AV. The blood pressure pendulum following spinal cord injury: implications for vascular cognitive impairment. Int J Mol Sci. 2019;20:2464.
Faaborg PM, Christensen P, Krassioukov A, Laurberg S, Frandsen E, Krogh K. Autonomic dysreflexia during bowel evacuation procedures and bladder filling in subjects with spinal cord injury. Spinal Cord. 2014;52:494–8.
Vaidyanathan S, Soni BM, Mansour P, Oo T. Fatal collapse due to autonomic dysreflexia during manual self-evacuation of bowel in a tetraplegic patient living alone: lessons to learn. Int Med Case Rep. J. 2017;10:361–5.
Wan D, Krassioukov AV. Life-threatening outcomes associated with autonomic dysreflexia: A clinical review. J Spinal Cord Med. 2014;37:2–10.
Krassioukov A, Warburton DE, Teasell R, Eng JJ. Spinal cord injury rehabilitation evidence research team. A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabil. 2009;90:682–95.
Liu N, Zhou M, Biering-Sørensen F, Krassioukov AV. Iatrogenic urological triggers of autonomic dysreflexia: a systematic review. Spinal Cord. 2015;53:500–9.
Pine ZM, Miller SD, Alonso JA. Atrial fibrillation associated with autonomic dysreflexia. Am J Phys Med Rehabilitation. 1991;70:271.
Eltorai I, Kim R, Vulpe M, Kasravi H, Ho W. Fatal cerebral hemorrhage due to autonomic dysreflexia in a tetraplegic patient: case report and review. Paraplegia. 1992;30:355–60.
Dolinak D, Balraj E. Autonomic dysreflexia and sudden death in people with traumatic spinal cord injury. Am J forensic Med Pathol. 2007;28:95–98.
Valles M, Benito J, Portell E, Vidal J. Cerebral hemorrhage due to autonomic dysreflexia in a spinal cord injury patient. Spinal Cord. 2005;43:738–40.
Yarkony GM, Katz RT, Wu YC. Seizures secondary to autonomic dysreflexia. Arch Phys Med Rehabil. 1986;67:834–5.
Krassioukov A, Linsenmeyer TA, Beck LA, Elliott S, Gorman P, Kirshblum S, et al. Evaluation and management of autonomic dysreflexia and other autonomic dysfunctions: preventing the highs and lows: management of blood pressure, sweating, and temperature dysfunction. J Spinal Cord Med. 2021;44:631–83.
Barkin RL. The pharmacology of topical analgesics. Postgrad Med. 2013;125(4 Suppl 1):7–18.
Furusawa K, Sugiyama H, Tokuhiro A, Takahashi M, Nakamura T, Tajima F, et al. Topical anesthesia blunts the pressor response induced by bowel manipulation in subjects with cervical spinal cord injury. Spinal Cord. 2009;47:144–8.
Lucci VM, McGrath MS, Inskip JA, Sarveswaran S, Willms R, Claydon VE, et al. Clinical recommendations for use of lidocaine lubricant during bowel care after spinal cord injury prolong care routines and worsen autonomic dysreflexia: results from a randomised clinical trial. Spinal Cord. 2020;58:430–40.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6:e1000100.
Higgins J, Altman DG Chapter 8: Assessing risk of bias in included studies. In: Higgins J, Green S, editors. Cochrane handbook for systematic reviews of interventions version 5.0.0: The Cochrane Collaboration.; 2008.
Tufanaru C, Munn Z, Aromataris E, Campbell J, Hopp L Chapter 3: Systematic reviews of effectiveness. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis: JBI; 2020.
Cosman BC, Vu TT. Lidocaine anal block limits autonomic dysreflexia during anorectal procedures in spinal cord injury: A randomized, double-blind, placebo-controlled trial. Dis Colon Rectum. 2005;48(AUG):1556–61.
Cosman BC, Vu TT, Plowman BK. Topical lidocaine does not limit autonomic dysreflexia during anorectal procedures in spinal cord injury: a prospective, double-blind study. Int J Colorectal Dis. 2002;17(MAR):104–8.
Matthews JM, Wheeler GD, Burnham RS, Malone LA, Steadward RD. The effects of surface anaesthesia on the autonomic dysreflexia response during functional electrical stimulation. Spinal Cord. 1997;35:647–51.
Solinsky R, Linsenmeyer TA. Intravesical lidocaine decreases autonomic dysreflexia when administered prior to catheter change. J Spinal Cord Med. 2019;42:557–61.
Gray K, Sheehan W, Wecht J, Linsenmeyer TA, Sachdeva R, Krassioukov AV, et al. Response to “Clinical recommendations for use of lidocaine lubricant during bowel care after spinal cord injury prolong care routines and worsen autonomic dysreflexia: results from a randomised clinical trial”. Spinal Cord. 2021 -09-30:1-2.
Lucci VM, McGrath MS, Inskip JA, Sarveswaran S, Willms R, Claydon VE, et al. Response to “Clinical recommendations for use of lidocaine lubricant during bowel care after spinal cord injury prolong care routines and worsen autonomic dysreflexia: results from a randomized clinical trial”—the authors reply. Spinal Cord. 2021;59:1311–2.
Hubli M, Gee CM, Krassioukov AV. Refined assessment of blood pressure instability after spinal cord injury. Am J Hypertension. 2015;28:173–81.
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’s 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.
The authors declare no competing interests.
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Gray, K., Sheehan, W., McCracken, L. et al. Are local analgesics effective in reducing autonomic dysreflexia in individuals with spinal cord injury? A systematic review. Spinal Cord (2022). https://doi.org/10.1038/s41393-022-00840-8