Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
권호 표지

Microstructural Changes after Intramuscular Injection of Lidocaine and Dexamethasone

Lidocaine과 dexamethasone 혼합용액의 근육내 주사 후 조직학적 변화

  • Jang, Seong-Min (Department of Oral Medicine, Institution of Oral Bioscience, College of Dentistry, Chonbuk National University) ;
  • Lee, Kyong-Eun (Department of Oral Medicine, Institution of Oral Bioscience, College of Dentistry, Chonbuk National University)
  • 장성민 (전북대학교 치과대학 구강내과학교실 및 구강생체과학연구소) ;
  • 이경은 (전북대학교 치과대학 구강내과학교실 및 구강생체과학연구소)
  • Published : 2005.03.30
Download PDF
⟨ Previous Next ⟩

Abstract

A trigger point injection (TPI) has been reported to have an immediate analgesic effect, and to be one of the most widely employed treatment methods of myofascial pain. There are normal saline, local anesthetics, and steroids as the solutions frequently used in TPI. They can be used separately or in combination. Local anaesthetics have myotoxicity in proportion to its concentration. The purpose of this study was to evaluate microstructural changes in point of the myotoxic effects of the combined solution of lidocaine and dexamethasone (a local anesthetic and a steroid) after being injected into the muscle of BALB/c mice. And this study tested solutions with various concentration separately and in combination, to find out proper concentration of solution without muscular tissue damage. This study shows that lidocaine and dexamethasone combination is not histologically myotoxic in case of the concentration of lidocaine less than 1.5%. Also it is suggested from this study that this combined solution will have an analgesic and anti-inflammatory effect. Hereafter continuous study should be performed to reveal that these results can be applied to human when lidocaine and dexamethasone combination is used as an injection modality of TrP treatment.

측두하악장애 및 구강안면통증 환자들 중 근막통증에 의한 기능제한이나 통증을 호소하는 경우를 흔히 볼 수 있다. 근막통증환자를 치료할 때 여러 가지 물리치료가 유용하지만, 즉각적인 통증완화효과를 나타내는 발통점주사요법이 근막통증의 치료로서 널리 적용되고 있다. 발통점주사요법에 흔히 사용하는 화학약제로 생리식염수, 국소마취제, 스테로이드 등이 있으며, 국소마취제는 근육에 대한 부작용이 보고되어 있어 사용상 주의가 필요하다. 이 연구는 상품화된 lidocaine과, dexamethasone 주사제의 혼합용액을 근육내 주사한 후 조직학적 변화를 관찰함으로써 근육에 대한 위해성 여부를 평가하고자 하였다. 또한 용액의 농도에 따라 각각 조직학적 변화를 관찰함으로써 위해성이 없는 적정한 농도를 제시하고자 하였다. 이 연구에서는 생후 9주된 BALB/c 생쥐 (자성) 63마리를 7군으로 분류하여, 앞정강근 (전경골근, tibialis cranialis) 에 각각 생리식염수, dexamethasone, 2.0% lidocaine, 생리식염수와 혼합한 1.0% lidocaine, 생리식염수와 혼합한 1.5% lidocaine, dexamethasone과 혼합한 1.0% lidocaine, dexamethasone과 혼합한 1.5% lidocaine을 주사하였다. 그 후 1일, 7일, 14일째에 희생시켜 실험부위를 절취한 후 조직절편을 만들어 HE염색과 Van-Gieson염색을 거쳐 광학현미경으로 관찰하여 다음의 결론을 얻었다. Lidocaine과 dexamethasone의 혼합용액을 근육내 주사하였을 때, lidocaine의 농도가 1.5% 이하인 경우 조직학적으로 유해하지 않았으며, 통증완화효과와 항염증작용을 동시에 기대할 수 있을 것으로 생각된다. 향후 상기 혼합용액을 발통점주사요법의 약제로 사용할 경우, 인체에서도 동일한 결과가 나올 것인가에 대해서는 추가적인 연구가 필요하다.

Keywords

References

  1. Gerwin RD, Shcannon S, Hong CZ. Hubbard D, Gevirtz R. Interrater reliability in myofascial trigger point examination. Pain, 1997;69:65-73 https://doi.org/10.1016/S0304-3959(96)03248-4
  2. Muhn KH, Chun YH, Hong JP. Possible mechanism of physical therapies for muscle disorders. Korean Journal of Oral Medicine, 2003;28(2):275-279
  3. Sherman JJ, Turk DC. Nonpharmacologic approaches to the management of myofascial temporomandibular disorders. Current Pain and Headache Reports 2001;5:421-431 https://doi.org/10.1007/s11916-001-0053-7
  4. Lewit K. The needle effect in the relief of myofascial pain. Pain 1979;6:83-90 https://doi.org/10.1016/0304-3959(79)90142-8
  5. Irnich D, Behrens N, Gleditsch JM, et al. Immediate effects of dry needling and acupuncture at distant points in chronic neck pain: results of a randomized, double-blind, sham-controlled crossover trial. Pain 2002;99:83-89 https://doi.org/10.1016/S0304-3959(02)00062-3
  6. Goddard G, Karibe H, McNeill C, Villafuerte E. Acupuncture and sham acupuncture reduce muscle pain in myofascial pain patients. Journal of orofacial pain 2002;16(1):71-76
  7. Han SC, Harrison P. Myofascial pain syndrome and trigger-point management. Reg Anesth. 1997;22 (1):89-101 https://doi.org/10.1016/S1098-7339(06)80062-3
  8. Criscuolo CM. Interventional approaches to the management of myofascial pain syndrome. Current Pain and Headache Reports 2001;5:407-411 https://doi.org/10.1007/s11916-001-0051-9
  9. Cao X. Scientific bases of acupuncture analgesia. Acupuncture & Electro-Therapeutics Res. 2002;27:1-14 https://doi.org/10.3727/036012902816026103
  10. Ernberg M, Hedenberg-Magnusson B, Alstergren P, Kopp S. Short-term effect of glucocorticoid injection into the superficial masseter muscle of patients with chronic myalgia: A comparison between fibromyalgia and localized myalgia. Journal of Orofacial Pain 1997;11:249-257
  11. Iwama H, Akama Y. The superiority of water-diluted 0.25% to neat 1.0% lidocaine for trigger-point injections in myofascial pain syndrome: A prospective, randomized, double-blinded trial. Anesthe Anal 2000;91:408-409
  12. Hong CZ. Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. Am J Phys Med Rehabil. 1994;73(4):256-263 https://doi.org/10.1097/00002060-199407000-00006
  13. Hameroff SR, Crago BR, Blitt CD, et al. Comparison of Bupivacaine, Etidocaine, and Saline for Trigger-Point Therapy. Anesth Analg. 1981;60:752-755
  14. Cox B, Durieux ME, Marcus MA. Toxicity of local anaesthetics. Best Practice & Research Clinical Anaesthesiology 2003;17(No.1):111-136 https://doi.org/10.1053/bean.2003.0275
  15. Foster AH, Carlson BM. Myotoxicity of local anesthetics and regeneration of the damaged muscle fibers. Anesth Analg 1980;59(10):727-736
  16. Grim M, Rerabkova L, Carlson BM. A Test for Muscle Lesions and their Regeneration Following Intramuscular Drug Application. Toxicologic Pathology 1988;16:432-442 https://doi.org/10.1177/019262338801600403
  17. Guttu RL, Page DG, Laskin DM. Delayed healing of muscle after injection of bupivacaine and steroid. Ann Dent. 1990;49(1):5-8
  18. Simons DG, Travell JG, Simons LS. General overview. In Eric P. Johnson(Ed). Travell & Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual. Vol. 1. Baltimore, 1999, Williams & Wilkins, pp. 57-86
  19. Baldry P. Management of myofascial trigger point pain. Acupunct Med. 2002;20(1):2-10 https://doi.org/10.1136/aim.20.1.2
  20. Fariss BL, Foresman PA, Rodeheaver GT, et al. Anesthetic properties and toxicity of bupivacaine and lidocaine for infiltrations anesthesia. The Journal of Emergency Medicine 1987;5:275-282 https://doi.org/10.1016/0736-4679(87)90255-1
  21. Benoit PW. Effects of local anesthetics on skeletal muscle. Anat Rec 1971;169:276-277
  22. Benoit PW, Belt WD. Some effects of local anesthetic agents on skeletal muscle. Exp Neurol 1972;34:264-278 https://doi.org/10.1016/0014-4886(72)90173-2
  23. Burke GW, Fedison JR, Jones CR. Muscle degeneration produced by local anesthetics. Va Dent J 1972;49:33-37
  24. Simons DG, Travell JG, Simons LS. Apropos of all muscles. In Eric P. Johnson(Ed). Travell & Simons' Myofascial Pain and Dysfunction : The Trigger Point Manual. Vol. 1. Baltimore, 1999, Williams & Wilkins, pp. 94-177