Abstract | BACKGROUND AND AIMS: PATIENTS AND METHODS: We enrolled patients with chronic, complete spinal cord injury scheduled for anoscopy and/or flexible sigmoidoscopy. In a double-blind fashion they were randomized to receive either 2% lidocaine jelly (n = 18) or nonmedicated lubricant (control; n = 32) just prior to the procedure. We measured blood pressure before, during, and after procedures. RESULTS: Mean maximal systolic blood pressure increased 35 +/- 25 mmHg in the lidocaine group vs. 45 +/- 30 mmHg in the control group (NS). However, there was a significant difference between anoscopic procedures and flexible sigmoidoscopies without anoscopy (49 +/- 29 vs. 25 +/- 20 mmHg). CONCLUSION: Topical lidocaine did not significantly limit or prevent autonomic dysreflexia in susceptible patients. Both anoscopy and flexible sigmoidoscopy caused significant blood pressure elevation. Anoscopy, which involves stretching of the anal sphincters, was a more potent stimulus for autonomic dysreflexia than flexible sigmoidoscopy, which involves gaseous distention of the rectosigmoid. Anal sphincter stretch and rectosigmoid distention, rather than a mucosal stimulus, are likely nociceptive triggers for procedure-associated autonomic dysreflexia.
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Authors | Bard C Cosman, Tri T Vu, Brian K Plowman |
Journal | International journal of colorectal disease
(Int J Colorectal Dis)
Vol. 17
Issue 2
Pg. 104-8
(Mar 2002)
ISSN: 0179-1958 [Print] Germany |
PMID | 12014417
(Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)
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Chemical References |
- Anesthetics, Local
- Lidocaine
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Topics |
- Administration, Topical
- Anesthetics, Local
(administration & dosage)
- Autonomic Dysreflexia
(etiology, prevention & control)
- Blood Pressure
- Double-Blind Method
- Female
- Hemorrhoids
(diagnosis, therapy)
- Humans
- Lidocaine
(administration & dosage)
- Ligation
- Male
- Proctoscopy
(adverse effects)
- Prospective Studies
- Sigmoidoscopy
(adverse effects)
- Spinal Cord Injuries
(physiopathology)
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