Comparison of Different Local Anesthetics in Cervical Facet Medial Branch Blockade
Condition: Pain, Neck
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      Neck pain is a common disease in society. In studies, the annual and lifetime prevalence was
      found to be 37.2% and 48.5%, respectively (1). Neck pain may be axial or radicular. Causes of
      axial neck pain include cervical strain, discogenic pain, cervical facet pain, spondylosis,
      whiplash, and myofascial pain. (2) Cervical facet degeneration is a common cause of axial
      neck pain (3). Pain originating from the cervical facet joint is localized to the midline of
      the neck and increases with neck extension. (2) Diagnosis is made by physical examination and
      radiological imaging. The distribution patterns of pain originating from the cervical facet
      joint vary depending on the level of the joint involved
    

Detailed description: 
      Neck pain is a common disease in society. Causes of axial neck pain include cervical strain,
      discogenic pain, cervical facet pain, spondylosis, whiplash, and myofascial pain. Cervical
      facet degeneration is a common cause of axial neck pain. Pain originating from the cervical
      facet joint is localized to the midline of the neck and increases with neck extension.
      Diagnosis is made by physical examination and radiological imaging. The distribution patterns
      of pain originating from the cervical facet joint vary depending on the level of the joint
      involved.

      Conservative treatment methods for facet joint pain are medical treatment and various
      physical therapy modalities. Interventional pain treatments are on the agenda for patients
      who cannot achieve effective pain palliation with conservative treatment. Since facet joints
      are innervated by the dorsal ramus, medial branch of the spinal nerves, medial branch
      blockade is applied in the treatment of facet-related pain. In cervical facet medial branch
      blockade, a mixture of local anesthetic and steroid is injected. Studies have found that
      adding steroids to local anesthetics increases injection effectiveness. Although there is no
      consensus on the type of steroid to be used, it is safer to use dexamethasone, a
      particle-free steroid, considering the dense vascular structure of the cervical region.
      However, the types of local anesthetic used in cervical facet medial branch blockade vary
      between studies. The type of local anesthetic used in cervical facet medial branch blockade
      in our clinic varies. There is only one study in the literature comparing local anesthetic
      types. Researchers compared the effectiveness of lidocaine and bupivacaine in cervical facet
      medial branch blockade without adding steroids. Researchers stated that lidocaine has a
      faster effect and longer duration of effect. Since there is no consensus on the type of local
      anesthetic, prilocaine or lidocaine is preferred in practice. This study aims to compare the
      effectiveness of lidocaine and prilocaine added to dexamethasone in cervical facet medial
      branch blockade, one of the routine treatment methods in our clinic.

      Within the scope of the study, patients deemed suitable for cervical facet medial branch
      injection will be randomly numbered for prilocaine or lidocaine injection through the
      computer program. 57 patients will receive lidocaine + steroid injection, 57 patients will
      receive prilocaine + steroid injection. Cervical facet medial branch injections will be
      administered. The evaluations of the patients before and after the procedure will be recorded
      by the researcher who is blind to the procedure performed. Demographic information of the
      patients, including age, gender, comorbidities, pain duration, and facet injection level,
      will be recorded before the procedure. Before the procedure, pain intensity will be evaluated
      using the NRS 11 scale, and functionality will be evaluated using the Neck Disability Index
      (NDI). The amount of medication used by the patients (non-steroidal anti-inflammatory
      analgesics, opioids, muscle relaxants) will also be noted.
    

Intervention name(s): facet median block with prilocain; facet median block with lidocaine
Intervention type(s): Procedure; Procedure
Intervention description(s): facet median block with prilocain; facet median block with lidocaine
Intervention MeSH terms: Lidocaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: pain; nerve block