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


Study design

Systematic review.


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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Fig. 1: Search strategy.
Fig. 2: Study design.

Data availability

Additional data may be provided by the corresponding author on reasonable request.


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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.

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Authors and Affiliations



WS, KG, RS, and AK designed the review. WS and KG conducted the database search. WS, KG, and LM screened and selected eligible articles, extracted the data and analyzed the quality of the included studies. Any discordance was settled by consensus between WS, KG and LM. WS, KG, and LM interpreted the results and wrote the first draft of the report. RS and AK provided theoretical feedback throughout the review process. WS, KG, KK, RS, and AK provided feedback on the manuscript and made edits to the final version. All authors approved the submission of the manuscript and declare no conflicts of interest.

Corresponding authors

Correspondence to Rahul Sachdeva or Andrei V. Krassioukov.

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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).

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