Changes in sensory loss following IV lidocaine in neuralgia

HAND HYPERSENSITIVITYAND THE UPPER LIMB TENSION TEST: ANOTHER ANGLR. J.E. Sweeney*,Dept. of Physiotherapy,Flinders Medical Centre, Adelaide;A.D. Harms, The Ashford Private Pain Clinic, Adelaide,South Australia,Australia.

Poster 102 BROWN ACC

Th-Fri

Hall

Abs No

E

906

AIM OF INVRSTIGATION: This pilot study examined the relationship r between patientswith a hand hypersensitivityproblem and their upper limb tension test (U.L.T.T.).The U.L.T.T. places longitudinaltension on the connectivetissue componentsof the brachial plexus (lower chords) and nerve trunks, particularlythe median nerve. METHODS: Twenty-ninepatients with unilateralhand hypersensitivityof surgical or traumaticorigin were evaluatedbefore and after a two week self-administeredmodified U.L.T.T. home stretch programme.The evaluationincludeda questionnaire;the visual analogue 'pain' scale, active range of movement tests and the U.L.T.T., for both the affected and unaffectedupper limbs. The evaluationU.L.T.T. compriseda starting position of full passive shoulder girdle depression,100 degrees passive glenohumeralabduction, full passive wrist and finger extensionand sustainingthis position,passive elbow extensionwas added until the hypersensitivitywas reproducedor the end of elbow range was reached. RESULTS: There was a significantdifferencebetween the patients'affected and unaffectedupper limbs when tested usinn the U.L.T.T.. both in rewoduction of hypersensitivityand in restrictionof &bow extensionat the test's end position (~(0.05). Following the home stretch programme,patients reported a significantreductionin their symptomsas measured by the visual analogue scale and by the U.L.T.T. (p
GMNGXS IN SENSORY LOSS F+OmG

IV LIDOCAIME IN NWHALGIA

P.MARCHETTINI, M. LACERENZAX, C. MARANGONI*, G. PELLEGATA*, S. SMIRNE*. NEUROLOGY DEPT., ISTITUTO SCIENTIFIC0 H. S. RAFFAELE AND UNIVERSITY OF MILANO, ITALY.

1

Poster 103 BROWN Th-Fri ACC Hall E Abs No

907

AIM OF INVESTIGATION: TO STUDY THE EFFECT OF IV LIDOCAINE ON NEURALGIA. METHODS: SIX PATIENTS WITH PAINFUL AMPUTATED NERVE UNDERWENT CLINICAL SENSORY EXAMINATION. THREE OF THE PATIENTS UNDERWENT QUANTITATIVE SENSORY TESTING (QTT) FOR WARM, COLD, HEAT PAIN AND COLD PAIN BY THE MARSTOCK METHOD. 100 MG LIDOCAINE IN 5 ML H20 WERE INJECTED IV AND THE EXAMINATION REPEATED. RESULTS: ALL PATIENTS PRESENTED SENSORY DYSFUNCTION IN A TERRITORY LARGER THAN THE CUTANEOUS DISTRIBUTION OF THE AMPUTATED PERIPHERAL NERVE, ALL SENSORY MODALITIES WERE AFFECTED AT DIFFERENT DEGREE. FOLLOWING IV LIDOCAINE, THE SPONTENEOUS PAIN DESAPPEARED AND THE AREA OF SENSORY LOSS SHRUNKED IN ALL PATIENTS. THE EFFECTS LASTED FOR lo-20 MINUTES. QTT OF THE AREA OF REVERSIBLE SENSORY LOSS SHOWED DECREASE OF THRESHOLDS AFTER LIDOCAINE: FOR WARM (3 PTS), COLD (2 PTS), HEAT PAIN (2 PTS), AND COLD PAIN (2 PTS). CONCLUSION: LIDOCAINE IV AFFECTS SENSORY FUNCTION IN NEURALGIA. THEREFORE, CARE SHOULD BE TAKEN IN EVALUATING THE EFFECTS OF LIDOCAINE LOCAL NERVE BLOCKS. THE TOPOGRAPHY OF SENSORY CHANGES SUGGESTS THAT BESIDES PERIPHERAL NERVE DAMAGE THERE IS A CNS DYSFUNCTION. LIDOCAINE MAY ACT PERIPHERALLY ON SPONTANEOUSLY FIRING AMPUTATED FIBERS OR CENTRALLY ON DEAFFERENTED NEURONS.