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PAIN MEDICINE

Lumbar Segmental Nerve Blocks with Local Anesthetics, Pain Relief, and Motor Function: A Prospective Double-Blind Study Between Lidocaine and Ropivacaine

André P. Wolff, MD^*,,, Oliver H. G. Wilder Smith, MD PhD, Ben J. P. Crul, MD PhD, Marc P. van de Heijden, and Gerbrand J. Groen, MD PhD

*Pain Centre, Department of Anaesthesiology, Bernhoven Hospital, Oss, The Netherlands; Pain Centre, Institute for Anaesthesiology, University Hospital Nijmegen, Nijmegen, The Netherlands; and Division of Perioperative Medicine, Anaesthesiology and Pain Treatment, University Medical Centre Utrecht, Utrecht, The Netherlands

Address correspondence and reprint requests to André P. Wolff, MD, Pain Centre, Institute for Anaesthesiology, University Hospital Nijmegen, PO Box 9101, 6500 HB Nijmegen, House Mail 520, The Netherlands. Address e-mail to a.wolff{at}anes.umcn.nl

Selective segmental nerve blocks with local anesthetics are applied for diagnostic purposes in patients with chronic back pain to determine the segmental level of the pain. We performed this study to establish myotomal motor effects after L4 spinal nerve blocks by lidocaine and ropivacaine and to evaluate the relationship with pain. Therefore, 20 patients, of which 19 finished the complete protocol, with chronic lumbosacral radicular pain without neurological deficits underwent segmental nerve blocks at L4 with both lidocaine and ropivacaine. Pain intensity scores (verbal numeric rating scale; VNRS) and the maximum voluntary muscle force (MVMF; using a dynamometer expressed in newtons) of the tibialis anterior and quadriceps femoris muscles were measured on the painful side and on the control side. The median VNRS decrease was 4.0 (P < 0.00001; Wilcoxon’s signed rank test), without significant differences between ropivacaine and lidocaine (Mann-Whitney U-test). A difference in effect on MVMF was found for affected versus control side (P = 0.016; Tukey test). Multiple regression revealed a significant negative correlation for change in VNRS score versus change in median MVMF (Spearman R = –0.48: P = 0.00001). This study demonstrates that in patients with unilateral chronic low back pain radiating to the leg, pain reduction induced by local anesthetic segmental nerve (L4) block is associated with increased quadriceps femoris and tibialis anterior MVMF, without differences for lidocaine and ropivacaine.

IMPLICATIONS: This study is the first to report on the relationship between a segmental nerve block, pain relief, and its effect on motor function in patients with chronic back pain radiating into the leg.

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