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Cardiac arrest in a 36 year-old after trigger point injection with lidocaine: Case report.

ABSTRACT: A typical vasovagal response is characterized by bradycardia and paradoxical vasodilation. It is oftentimes self-limited and spontaneously reversible; however, severe cases can result in significant complications. This report describes a case of profound vasovagal syncope with subsequent cardiac arrest in the setting of receiving a trigger point injection. This patient presented to an outpatient clinic for ultrasound-guided left trapezius, levator scapulae, and rhomboid trigger point injections for relief of myofascial pain. One milliliter of 1% lidocaine was injected into the first trigger point when she stated she felt dizzy before becoming unresponsive without palpable peripheral pulses. The patient regained consciousness following cardiopulmonary resuscitation (CPR). Considering the frequency of office based pain procedures, it is important to recognize the potential serious complications associated with procedures frequently thought to be benign.

SUBMITTER: Hattenbach J

PROVIDER: S-EPMC11373063 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Cardiac arrest in a 36 year-old after trigger point injection with lidocaine: Case report.

Hattenbach Jacob J Ishii Haruki H Mastanduno Samantha S Espiritu McKay Tracy T

Interventional pain medicine 20220302 3

A typical vasovagal response is characterized by bradycardia and paradoxical vasodilation. It is oftentimes self-limited and spontaneously reversible; however, severe cases can result in significant complications. This report describes a case of profound vasovagal syncope with subsequent cardiac arrest in the setting of receiving a trigger point injection. This patient presented to an outpatient clinic for ultrasound-guided left trapezius, levator scapulae, and rhomboid trigger point injections ...[more]

PMID: 39238517

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Project description:BackgroundImmune thrombocytopenia (ITP) is a rare autoimmune disorder characterized by low platelet counts and increased bleeding risk. The disease may be induced by other disorders, including malignancies, autoimmune diseases, infectious agents or drugs. However, ITP has also been described following vaccinations, such as the measles-mumps-rubella vaccination. In rare cases, ITP may occur in children who received a DTaP-IP (diphtheria, tetanus, acellular pertussis vaccine and inactivated poliovirus) vaccine. Hereinafter, we report the first well-documented cases of ITP in an adult patient in the temporal context of a DTaP-IP vaccination.Case presentationThis case report attempts to capture the life-threatening picture of a 36-year-old otherwise healthy Caucasian woman with newly diagnosed severe immune thrombocytopenia in the temporal context of a DTaP-IP vaccination. Four days after receiving the vaccine, the women presented to her primary care physician with malaise, fever and recurrent epistaxis. Clinical examination revealed oral petechiae, ecchymoses, and non-palpable petechiae on both legs. The patient was immediately referred to a local hematology unit where she developed hematuria and an intestinal bleeding (WHO Bleeding Grade III) requiring multiple transfusions. After receiving oral corticosteroids and intravenous immunoglobulins, her platelets gradually recovered. Common causes of secondary ITP were ruled out by laboratory investigations, bone marrow and peripheral blood examinations. This raises the possibility of a (secondary) vaccination-associated thrombocytopenia. To the best of our knowledge, this is the first well-documented case of a DTaP-IP vaccination-related ITP in an adult patient in the English literature.ConclusionAlthough a causal connection between both entities may not be established, we would like to raise awareness in clinicians that ITP following DTaP-IP vaccinations is potentially not limited to children, but may also occur in adults. Users of DTaP-IP booster vaccines should be alert of the possibility of such adverse reactions.

Project description:BackgroundThere is no evidence that antiarrhythmic drugs can improve long-term survival or survival with favorable neurological outcomes in cardiac arrest patients. We did this network meta-analysis to comprehensively compare the efficacy of various antiarrhythmic drugs for cardiac arrest patients.MethodsWe searched studies from inception until Nov 11, 2022 through PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP Database, and Wanfang database. All studies comparing different antiarrhythmic drugs for cardiac arrest were included in this meta-analysis. Outcomes were survival to hospital discharge in cardiac arrest, survival to hospital admission/24 h and favorable neurological outcome. This network meta-analysis was performed by R software.ResultsFinally, a total of 9 studies (10,980 patients) were finally included in this network meta-analysis. Amiodarone (odd ratio [OR] 2.28, 95% credibility interval [CrI] 1.61-3.27) and lidocaine (OR 1.53, 95% CrI 1.05-2.25) was superior than placebo in terms of the survival to hospital admission/24 h with statistically significant. Amiodarone (OR 2.19, 95% CrI 1.54-3.14) and lidocaine (OR 1.58, 95% CrI 1.09-2.32) was superior than placebo in terms of the survival to hospital discharge with statistically significant. Amiodarone (OR 2.43, 95% CrI 1.61-3.68) and lidocaine (OR 1.62, 95% CrI 1.04-2.53) was superior than placebo in terms of the favorable neurological outcome with statistically significant. The surface under the cumulative ranking (SUCRA) shows that amiodarone ranked first (SUCRA, 99.6%), lidocaine ranked second (SUCRA, 49.6%), placebo ranked the last (SUCRA, 0.86%). Inverted funnel plot is essentially symmetrical, it is possible that this study has a small sample effect or a small publication bias.ConclusionsAmiodarone had the best effect on both survival to hospital admission, discharge and more favorable neurological outcome. Thus, amiodarone should be listed as first line drug for cardiac arrest. However, the quality of available evidence limits the formation of powerful conclusions regarding the comparative efficacy or safety of amiodarone or lidocaine used to treat cardiac arrest. Higher-quality randomized controlled trials are required for further research in future.

Project description:To assess the comparative effectiveness and harms of trigger point injections (TPI) for myofascial neck and back pain. Electronic literature databases were searched to identify articles pertaining to TPI for chronic myofascial neck and back pain. Searches were done from database start dates up to April 2020. Inclusion criteria were randomized controlled trials, cohorts, and case control studies. Pain, functional outcomes, and harms were extracted. Outcome time points were divided into short term (7 days to <6 weeks), intermediate term (6 weeks to < 3 months), long term (3 months to < 6 months), and longest term (>6 months). Quality assessment was done using the Cochrane Back Review Group (CBRG) checklist for RCTs, and the Newcastle-Ottawa Quality Assessment Scale for cohort and case control studies. 14 studies met inclusion criteria. Six studies compared TPI of Botulinum toxin A (five with Onabutulinum toxin A, and one with Abobotulinum toxin A) with normal saline (NS). Two of the Onabotulinum toxin A studies showed greater pain improvement in the Onabotulinum toxin A group at short, intermediate, compared with NS. The Abobotulinum study showed pain improvement at short, intermediate, and long terms. Of note Onabotulinum toxin A was associated with improved anxiety and depression in two studies. Two studies compared Onabotulinum toxin A to local anesthetic, one to methylprednisolone, and one to dry needling (DN), all of which showed no difference. One study compared Ozone to Lidocaine and DN, and it showed no difference. Two studies compared sterile water to NS; they both found no difference in pain outcomes at the short term time point. However one of these two studies showed improved pain at intermediate, long, and longest terms in the sterile water group. Tropisetron showed no difference vs. NS. Adverse effects were mostly reported for Onabotulinum toxin A and Abobotulinum toxin A. Given the mixed results, we are unable to conclude whether an injectate composition is superior to another, or make recommendations in that regard. Further studies will help elucidate the ideal injectate composition and parameters.

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Cardiac arrest in a 36 year-old after trigger point injection with lidocaine: Case report.

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Cardiac arrest in a 36 year-old after trigger point injection with lidocaine: Case report.

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