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Water-Diluted Local Anesthetic for Trigger-Point Injection in Chronic Myofascial Pain Syndrome: Evaluation of Types of Local Anesthetic and Concentrations in Water
  1. Hiroshi Iwama, M.D.,
  2. Satoshi Ohmori, M.D.,
  3. Toshikazu Kaneko, M.D. and
  4. Kazuhiro Watanabe, M.D.
  1. From the Department of Anesthesiology, Central Aizu General Hospital, Aizuwakamatsu, Japan.
  1. Reprint requests: Hiroshi Iwama, M.D., Department of Anesthesiology, Central Aizu General Hospital, 1-1 Tsuruga-machi, Aizuwakamatsu City 965-0011, Japan.


Background and Objectives We have recently demonstrated that a mixture of 1% lidocaine with water in a 1:3 ratio has less injection pain and is more effective than unaltered 1% lidocaine in treating chronic myofascial pain syndromes. Yet, the most suitable local anesthetic and the most effective dilution in water have not been evaluated.

Methods Various mixtures of local anesthetics and water or saline were injected intramuscularly into the shoulder of 40 female volunteers, and pain scores on injection were evaluated in a randomized and double-blinded manner. In another portion of the study, 0.25% or 0.2% lidocaine in water were injected randomly into 1 side of 21 outpatients with chronic neck, shoulder, or lumbar myofascial pain to the same degree in both sides. The other solution was injected into the other side of the same patients.

Results Less injection pain was experienced with the water-diluted 0.25% lidocaine and water-diluted 0.25% mepivacaine than the saline-diluted 0.25% lidocaine and water-diluted 0.0625% bupivacaine. Also, less injection pain was experienced with the water-diluted 0.25% and 0.2% lidocaine than the water-diluted 0.3% and 0.15% lidocaine. In the other study, there were no differences in either the effectiveness or duration of analgesia between the 0.25% and 0.2% water-diluted lidocaine.

Conclusions The suitable type of local anesthetic may be lidocaine or mepivacaine, and the most effective water-diluted concentration is considered to be 0.2% to 0.25%.

  • Myofascial pain syndrome
  • Trigger-point
  • Intramuscular injection
  • Local anesthetic
  • Water
  • Saline

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