Intravesical lidocaine decreases autonomic dysreflexia when administered prior to catheter change

The Journal of Spinal Cord Medicine, 2019 · DOI: 10.1080/10790268.2018.1518764 · Published: September 1, 2019

Simple Explanation

Autonomic dysreflexia (AD) is a dangerous rise in blood pressure that can happen in people with spinal cord injuries (SCI). This is more common in injuries at or above T6. The study looked at whether putting lidocaine (a numbing medicine) into the bladder before a catheter change could prevent AD. The study found that giving lidocaine before the catheter change significantly lowered the chance of AD happening and also reduced how high the blood pressure went up.

Study Duration

Not specified

Participants

50 individuals with SCI at or above T6 and a history of AD

Evidence Level

Prospective observational cohort study

Key Findings

1
Pretreatment with intravesical lidocaine significantly reduced the incidence of AD during catheter changes.
2
The magnitude of SBP rise was significantly attenuated in the lidocaine pretreatment group compared to the control group.
3
The number needed to treat (NNT) to prevent one episode of AD with lidocaine pretreatment was 3.0.

Research Summary

This study evaluated the efficacy of intravesical lidocaine in preventing autonomic dysreflexia (AD) during routine catheter changes in individuals with spinal cord injury (SCI) at or above T6. The results demonstrated that pretreatment with intravesical lidocaine significantly decreased both the incidence and magnitude of AD compared to a control group. The findings suggest that pretreatment with intravesical lidocaine is a helpful intervention for individuals with SCI who are prone to AD during catheter changes.

Practical Implications

Clinical Practice

Consider pretreatment with intravesical lidocaine prior to catheter changes in individuals with SCI at risk for AD to reduce the incidence and magnitude of AD.

Reduced Morbidity

Mitigate risks associated with blood pressure fluctuations, such as cognitive deficits and cardiovascular disease, by using intravesical lidocaine during catheter changes.

Guideline Support

The findings support the consortium guidelines for AD management, providing evidence for the use of intravesical lidocaine in AD management.

Study Limitations

1
The study was a prospective observational cohort study, which may have introduced selection bias.
2
Differences in catheter diameter may have led to variable amounts of lidocaine reaching the bladder mucosa.
3
Clinical testing to date has not been able to fully characterize the predisposition an individual may have to varying degrees of AD

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