Evaluation of the Effect of Intranasal Lidocaine in the Treatment of Spasticity in Patients with Traumatic Brain Injury

Anoush Dehnadi Moghadam, Hamed Hasanzadeh, Fatemeh Dehnadi Moghadam, Anoush Dehnadi Moghadam, Hamed Hasanzadeh, Fatemeh Dehnadi Moghadam

Abstract

Background: Spasticity following traumatic brain injury (TBI) is one of the most significant barriers of returning patients to their normal life. Spasticity caused by TBI does not have a specific or definitive treatment, and the clinical effect of pharmacologic treatments has not been significant.

Methods: In this single-arm study, we evaluated 15 patients. For each patient with spasticity, treatment with oral baclofen 25 mg was started three times a day as a part of standard therapy. After 48 hours, if the spasticity did not decrease by at least one score in the Modified Tardieu or Ashworth scales, lidocaine 0.5% was administered as a continuous intranasal infusion. The initial dose of lidocaine was 1 mg/min, which was gradually increased to 2 mg/min. Spasticity and the frequency of spasms were assessed by Ashworth and modified tardieu scales (MTS) and Spasm Frequency Score (SFS), respectively. Heart rate (HR), respiratory rate (RR), mean arterial blood pressure (MAP), Richmond Agitation-Sedation Scale (RASS), Glasgow Coma Scale (GCS), and arterial oxygen saturation (SPo2) of patients were recorded during nine days of treatment. All data were analyzed by SPSS version 21. P-value less than 0.05 was considered as statistically significant.

Results: Out of 15 participants in this study, 13 (86.7%) were male, and 2 (13.3%) were female (mean age: 29.26 ± 12.5 years). There were no significant differences in Ashworth Scale, Modified Tradieu Scale, RASS Score, GCS Score, MAP, SPo2 percentage, HR, RR, and the number of spasms per day between the time of initiation of treatment and the second day of baclofen treatment (P > 0.05). Evaluation of spasticity using Ashworth scale on the first and last days of lidocaine treatment showed a significant decrease in the mean spasticity (3.46 ± 0.51 and 1.46 ± 0.91, respectively; P < 0.001). Spasticity assessment using the MTS showed a significant reduction in the mean of the last day of treatment compared to the mean of the first day of treatment (3.6 ± 0.5 and 1.26 ± 0.51, respectively; P < 0.001). This decrease was also seen in the mean of the last day of treatment compared to the first day in SFS (13.3 ± 3.88 and 3.8 ± 0.51, respectively; P < 0.001). Comparison of HR, RR, MAP, RASS, GCS, and SPo2 on the first and last days of treatment did not show any statistical differences.

Conclusions: Although continuous intranasal treatment with lidocaine can be effective in spasm reduction of patients with TBI, further studies with larger sample sizes and longer follow-up periods are required.

Keywords: Intranasal; Lidocaine; Traumatic Brain Injury; Treatment.

Conflict of interest statement

Conflict of Interests: The authors declared that there is no conflict of interest.

Copyright © 2021, Author(s).

Figures

Figure 1.. Changes in Modified Ashworth Scale…
Figure 1.. Changes in Modified Ashworth Scale Values during Treatment with Lidocaine 0.5% in Patients with Traumatic Brain Injury

References

    1. Enslin JMN, Rohlwink UK, Figaji A. Management of spasticity after traumatic brain injury in children. Front Neurol. 2020;11:126. doi: 10.3389/fneur.2020.00126.
    1. Rimaz S, Ashraf A, Marzban S, Haghighi M, Zia Ziabari SM, Biazar G, et al. Significance of cardiac troponin I elevation in traumatic brain injury patients. Anesth Pain Med. 2019;9(2):e90858. doi: 10.5812/aapm.90858.
    1. Roozenbeek B, Maas AI, Menon DK. Changing patterns in the epidemiology of traumatic brain injury. Nat Rev Neurol. 2013;9(4):231–6. doi: 10.1038/nrneurol.2013.22.
    1. Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, et al. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2018:1–18. doi: 10.3171/2017.10.JNS17352.
    1. Mossberg KA, Amonette WE, Masel BE. Endurance training and cardiorespiratory conditioning after traumatic brain injury. J Head Trauma Rehabil. 2010;25(3):173–83. doi: 10.1097/HTR.0b013e3181dc98ff.
    1. Pattuwage L, Olver J, Martin C, Lai F, Piccenna L, Gruen R, et al. Management of spasticity in moderate and severe traumatic brain injury: Evaluation of clinical practice guidelines. J Head Trauma Rehabil. 2017;32(2):E1–E12. doi: 10.1097/HTR.0000000000000234.
    1. Cimino V, Chisari CG, Patti F. Spasticity and dystonia: A brief. In: Larrivee D, Rayegani SM, editors. Neurostimulation and Neuromodulation in Contemporary Therapeutic Practice. Norderstedt, Germany: Books on Demand; 2020. p. 113.
    1. Ganguly J, Kulshreshtha D, Almotiri M, Jog M. Muscle tone physiology and abnormalities. Toxins (Basel). 2021;13(4) doi: 10.3390/toxins13040282.
    1. Trompetto C, Marinelli L, Mori L, Pelosin E, Curra A, Molfetta L, et al. Pathophysiology of spasticity: Implications for neurorehabilitation. Biomed Res Int. 2014;2014:354906. doi: 10.1155/2014/354906.
    1. Rekand T, Hagen EM, Gronning M. Spasticity following spinal cord injury. Tidsskr Nor Laegeforen. 2012;132(8):970–3. doi: 10.4045/tidsskr.10.0872.
    1. Boulenguez P, Liabeuf S, Bos R, Bras H, Jean-Xavier C, Brocard C, et al. Down-regulation of the potassium-chloride cotransporter KCC2 contributes to spasticity after spinal cord injury. Nat Med. 2010;16(3):302–7. doi: 10.1038/nm.2107.
    1. Synnot A, Chau M, Pitt V, O'Connor D, Gruen RL, Wasiak J, et al. Interventions for managing skeletal muscle spasticity following traumatic brain injury. Cochrane Database Syst Rev. 2017;11:CD008929. doi: 10.1002/14651858.CD008929.pub2.
    1. Bose P, Hou J, Thompson FJ. Traumatic brain injury (TBI)-induced spasticity. In: Kobeissy FH, editor. Brain neurotrauma: Molecular, neuropsychological, and rehabilitation aspects. Florida, USA: CRC Press; 2015.
    1. Nakhostin Ansari N, Naghdi S, Jamshidi AA, Entezary E, Tabatabaei A, Jannat D. [Relationship between the Modified Modified Ashworth Scale and the biomechanical measure in assessing knee extensor muscle spasticity in patients with post-stroke hemiparesia: A pilot study]. Avicenna Journal of Clinical Medicine (Scientific Journal of Hamadan University of Medical Sciences and Health Services). 2014;21(2):131–6.
    1. Sunnerhagen KS, Olver J, Francisco GE. Assessing and treating functional impairment in poststroke spasticity. Neurology. 2013;80(3 Suppl 2):S35–44. doi: 10.1212/WNL.0b013e3182764aa2.
    1. Ghotbi N, Nakhostin Ansari N, Naghdi S, Hasson S. Measurement of lower-limb muscle spasticity: Intrarater reliability of Modified Modified Ashworth Scale. J Rehabil Res Dev. 2011;48(1):83–8. doi: 10.1682/jrrd.2010.02.0020.
    1. Martens G, Foidart-Dessalle M, Laureys S, Thibaut A. Coma and disorders of consciousness. New York, USA: Springer; 2018. How does spasticity affect patients with disorders of consciousness? pp. 119–35.
    1. Saeidi M, Alikhani R, Hormati A, Sabouri SM, Aminnejad R. Propofol-induced masseter muscle spasm in a woman with a major depressive disorder. Anesth Pain Med. 2018;8(3):e78748. doi: 10.5812/aapm.78748.
    1. Chang E, Ghosh N, Yanni D, Lee S, Alexandru D, Mozaffar T. A review of spasticity treatments: Pharmacological and interventional approaches. Crit Rev Phys Rehabil Med. 2013;25(1-2):11–22. doi: 10.1615/CritRevPhysRehabilMed.2013007945.
    1. Khan ZH, Samadi S, Ameli S, Emir Alavi C. Lidocaine as an induction agent for intracranial aneurysm surgery: A case series. Anesth Pain Med. 2016;6(1):e33250. doi: 10.5812/aapm.33250.
    1. Chen C, Zhou X, He J, Xie Z, Xia S, Lu G. The roles of GABA in ischemia-reperfusion injury in the central nervous system and peripheral organs. Oxid Med Cell Longev. 2019;2019:4028394. doi: 10.1155/2019/4028394.
    1. Garmon EH, Huecker MR. Topical, local, and regional anesthesia and anesthetics. Florida, USA: StatPearls; 2021.
    1. Moradi Z, Kokabi R, Ahrari F. Comparison of the effects of lidocaine-prilocaine cream and lidocaine injection on the reduction of perineal pain while doing and repairing episiotomy in natural vaginal delivery: Randomized clinical trial. Anesth Pain Med. 2019;9(3):e90207. doi: 10.5812/aapm.90207.
    1. Tully J, Jung JW, Patel A, Tukan A, Kandula S, Doan A, et al. Utilization of intravenous lidocaine infusion for the treatment of refractory chronic pain. Anesth Pain Med. 2020;10(6):e112290. doi: 10.5812/aapm.112290.
    1. Imani F, Khajavi M, Gavili T, Pourfakhr P, Shariat Moharari R, Etezadi F, et al. Comparison of the effect of intra-rectal administration of lidocaine gel and lidocaine plus fentanyl on pain reduction in prostate biopsy: A randomized clinical trial. Anesth Pain Med. 2018;8(6):e82778. doi: 10.5812/aapm.82778.
    1. Sarchielli P, Granella F, Prudenzano MP, Pini LA, Guidetti V, Bono G, et al. Italian guidelines for primary headaches: 2012 revised version. J Headache Pain. 2012;13(Suppl 2):S31–70. doi: 10.1007/s10194-012-0437-6.
    1. Chandra S, Pryambodho P, Melati AC, Kusuma RI. Comparison between lidocaine inhalation and intravenous dexamethasone in reducing postoperative sore throat frequency after laryngeal mask insertion. Anesth Pain Med. 2018;8(5):e82131. doi: 10.5812/aapm.82131.
    1. Ghasemi M, Mosaffa F, Hoseini B, Behnaz F. Comparison of the effect of bicarbonate, hyaluronidase, and lidocaine injection on myofascial pain syndrome. Anesth Pain Med. 2020;10(3):e101037. doi: 10.5812/aapm.101037.
    1. Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80(1):6–15. doi: 10.1227/NEU.0000000000001432.
    1. Halili H, Azizkhani R, Tavakoli Garmaseh S, Jafarpisheh MS, Heydari F, Masoumi B, et al. Comparing the effect of lidocaine-prilocaine cream and infiltrative lidocaine on overall pain perception during thoracentesis and abdominocentesis: A randomized clinical trial. Anesth Pain Med. 2021;11(1):e106275. doi: 10.5812/aapm.106275.
    1. Fathy W, Hussein M, Khalil H. Comparative effect of local anesthesia with lidocaine 2% versus topical anesthesia on cognitive function in ophthalmic surgery. Anesth Pain Med. 2019;9(6):e97172. doi: 10.5812/aapm.97172.
    1. Soltani F, Tabatabaei SK, Jannatmakan F, Nasajian N, Amir F, Darkhor R, et al. Comparison of the effects of haloperidol and dexmedetomidine on delirium and agitation in patients with a traumatic brain injury admitted to the intensive care unit. Anesth Pain Med. 2021;11(3):e113802. doi: 10.5812/aapm.113802..
    1. Oriby ME. Comparison of intranasal dexmedetomidine and oral ketamine versus intranasal midazolam premedication for children undergoing dental rehabilitation. Anesth Pain Med. 2019;9(1):e85227. doi: 10.5812/aapm.85227.
    1. Jose de A, Luciano P, Vicente V, Juan Marcos AS, Gustavo FC. Role of catheter's position for final results in intrathecal drug delivery. Analysis based on CSF dynamics and specific drugs profiles. Korean J Pain. 2013;26(4):336–46. doi: 10.3344/kjp.2013.26.4.336.
    1. Wang ZM, Law JH, King NK, Rajeswaran DK, Soh S, Rao JP, et al. Treatment of severe, disabling spasticity with continuous intrathecal baclofen therapy following acquired brain injury: The experience of a tertiary institution in Singapore. Singapore Med J. 2016;57(1):8–12. doi: 10.11622/smedj.2016005.
    1. Bakhshaei MH, Manuchehrian N, Khoshraftar E, Mohamadipour-Anvary H, Sanatkarfar M. Analgesic effects of intrathecal sufentanil added to lidocaine 5% in elective cesarean section. Acta Med Iran. 2010;48(6):380–4.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다