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

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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 ( IF 2.2 ) Pub Date : 2019-11-25 , DOI: 10.1038/s41393-019-0381-2
Vera-Ellen M Lucci _{1,

2} , Maureen S McGrath _{1,

2} , Jessica A Inskip _{1,

2} , Shirromi Sarveswaran ₁ , Rhonda Willms _{2,

3,

4} , Victoria E Claydon _{1,

2}

Affiliation

Study design

Clinical trial.

Objective

Spinal cord injury (SCI) impacts autonomic function and bowel management. Bowel care is a potential trigger for autonomic dysreflexia (AD; paroxysmal hypertension elicited by sensory stimuli below the level of lesion). AD can be life threatening so strategies to minimise AD are prioritised after SCI. Lidocaine lubricant is recommended during bowel care with the rationale to minimise the sensory stimulus, reducing AD. The objective of this study was to assess whether lidocaine lubricant (Xylocaine 2%) ameliorates AD during at-home bowel care compared with standard lubricant (placebo).

Setting

Community.

Method

Participants (n = 13; age 44.0 ± 3.3 years) with high-level SCI (C3-T4) performed their normal at-home bowel care on two days, each time using a different lubricant, with continuous non-invasive cardiovascular monitoring. Injury to spinal autonomic (sympathetic) nerves was determined from low-frequency systolic arterial pressure (LF SAP) variability.

Results

Participants displayed reduced autonomic function (LF SAP 3.02 ± 0.84 mmHg²), suggesting impaired autonomic control. Bowel care duration was increased with lidocaine (79.1 ± 10.0 min) compared to placebo (57.7 ± 6.3 min; p = 0.018). All participants experienced AD on both days, but maximum SAP was higher with lidocaine (214.3 ± 10.5 mmHg) than placebo (196.7 ± 10.0 mmHg; p = 0.046). Overall, SAP was higher for longer with lidocaine (6.5 × 10⁵ ± 0.9 × 10⁵ mmHg • beat) than placebo (4.4 × 10⁵ ± 0.6 × 10⁵ mmHg • beat; p = 0.018) indicating a higher burden of AD. Heart rate and rhythm disturbances were increased during AD, particularly with lidocaine use.

Conclusions

At-home bowel care was a potent trigger for AD. Our findings contradict recommendations for lidocaine use during bowel care, suggesting that anaesthetic lubricants impair reflex bowel emptying, resulting in longer care routines with an increased burden of AD.

中文翻译：

脊髓损伤后肠道护理期间使用利多卡因润滑剂的临床建议会延长护理程序并加重自主神经反射障碍：一项随机临床试验的结果。

学习规划

临床试验。

客观的

脊髓损伤 (SCI) 影响自主神经功能和肠道管理。肠道护理是自主神经反射异常（AD；由低于病变水平的感觉刺激引起的阵发性高血压）的潜在触发因素。AD 可能会危及生命，因此在 SCI 之后优先考虑最小化 AD 的策略。在肠道护理期间推荐使用利多卡因润滑剂，其理由是尽量减少感觉刺激，减少 AD。本研究的目的是评估与标准润滑剂（安慰剂）相比，利多卡因润滑剂（Xylocaine 2%）在家庭肠道护理期间是否能改善 AD。

环境

社区。

方法

患有高水平 SCI (C3-T4) 的参与者 ( n = 13; 年龄 44.0 ± 3.3 岁) 在两天内进行了正常的家庭肠道护理，每次使用不同的润滑剂，并进行连续的无创心血管监测。脊髓自主（交感）神经损伤由低频收缩动脉压（LF SAP）变异性确定。

结果

参与者表现出自主神经功能降低（LF SAP 3.02 ± 0.84 mmHg ²），表明自主神经控制受损。与安慰剂相比（57.7 ± 6.3 分钟；p = 0.018），利多卡因组的肠道护理时间延长（79.1 ± 10.0 分钟）。所有参与者在这两天都经历了 AD，但利多卡因的最大 SAP (214.3 ± 10.5 mmHg) 高于安慰剂 (196.7 ± 10.0 mmHg; p = 0.046)。^{总体而言，利多卡因组（6.5 × 10 5} ± 0.9 × 10 ⁵ mmHg • beat）的 SAP 持续时间高于安慰剂组（4.4 × 10 ⁵ ± 0.6 × 10 ⁵ mmHg • beat；p = 0.018）表明 AD 负担较高。AD 期间心率和节律紊乱增加，尤其是在使用利多卡因时。