Studies evaluating the false-positive and false-negative rates of cervical MBBs
| Study | No of subjects | Methodology | Prevalence | False-positive/ negative rate | Comments |
| Barnsley et al 1993188 | 55 pts (60 joints) | Near-complete relief with lidocaine and bupivacaine MBB, with the duration of relief lasting longer with bupivacaine | 73% | FP rate 27% (2 pts had relief with only 1 block while 14 had longer relief with lidocaine) | All pts had at least one positive block (no negatives). All pts had whiplash after an MVC |
| Barnsley et al 1993227 | 47 pts | Near-complete relief with lidocaine and bupivacaine MBB, with the duration of relief lasting longer with bupivacaine but not longer than the expected duration (7 hours for lidocaine, 24 for bupivacaine) | 57% | FP rate 40% (1 of 45 pts had no relief after second block while 17 had discordant or prolonged relief) | All pts had whiplash after an MVC. Only 2 of 47 pts obtained insufficient relief from initial block |
| Barnsley et al 199510 | 50 pts | Near-complete relief with lidocaine and bupivacaine MBB, with the duration of relief lasting longer with bupivacaine | 54% | FP rate 26% (2 of 38 had pain relief with only 1 block while 8 had longer relief with lidocaine) | All pts had whiplash after an MVC. 7 pts withdrew and 5 only completed one block |
| Lord et al 1995189 | 50 pts | Near-complete relief with lidocaine and bupivacaine MBB, with the duration of relief lasting longer with bupivacaine but not longer than the expected duration (7 hours for lidocaine, 24 for bupivacaine) and a negative response to saline | 26% based on concordant response to LA blocks and negative response to saline | FP rate 19% based on concordant response to LA but (+) response to saline. In placebo negative responders, FP rate 63% based on discordant or prolonged concordant response to lidocaine and bupivacaine. FN rate 32% based on positive but discordant response to lidocaine and bupivacaine but negative response to saline | 20 pts responded to saline injections, including 3 of 14 who had concordant response to lidocaine and bupivacaine |
| Manchikanti et al 2002418 | 120 pts with axial neck pain | >80% pain relief after MBB with lidocaine followed by bupivacaine | 67% | FP rate 24% based on initial positive blocks | Required at least 2 hours relief with lidocaine and 3 hours with bupivacaine. Mixed sarapin and steroids with LA. All pts sedated |
| Manchikanti et al 20026 | 106 pts with neck pain with or without arm pain | >75% pain relief after MBB with lidocaine followed by bupivacaine | 60% | FP rate 21% based on initial positive blocks | Required at least 90 min relief with lidocaine and 3 hours with bupivacaine. Some patients had radicular pain. All pts sedated |
| Manchikanti et al 2004419 | 255 pts with neck pain | >80% relief during painful movements after MBB with lidocaine followed by bupivacaine | 55% | FP rate 34% based on initial positive blocks | Required at least 2 hours relief with lidocaine and 3 hours with bupivacaine. All pts sedated |
| Manchikanti et al 200814 | 251 pts with non-radicular neck pain with (n=45) and without (n=206) prior surgery | >80% relief and ability to perform previously painful movements after MBB with lidocaine followed by bupivacaine | 39% in non-surgical and 36% in post-surgical pts | FP rate 43% in non-surgical group, 50% in post-surgical group | Required at least 2 hours relief with lidocaine and 3 hours with bupivacaine. All pts sedated |
| Manchukonda et al 2007416 | 251 pts with non-radicular neck pain | >80% relief and ability to perform previously painful movements after MBB with lidocaine followed by bupivacaine | 39% | FP rate 45% | Retrospective study. Required at least 2 hours relief with lidocaine and 3 hours with bupivacaine. Many had involvement of other spinal regions. All pts sedated. Results nearly identical to reference 14 |
| Yin and Bogduk, 2008420 | 84 pts with non-radicular neck pain | Complete pain relief after MBB lasting longer with bupivacaine than lidocaine. Those with discordant relief had to have negative block to placebo | 55% | FP rate 15% | Retrospective study |
| Speldewinde et al 20019 | 97 pts with disabling axial neck pain | Near-complete pain relief (post-block pain score ≤1/10) after MBB done with lidocaine and bupivacaine | 36% based only on confirmatory double blocks, 55% if 18 pts who did not receive a confirmatory block are included | FP rate 0%, though 18 of the 53 pts with a (+) initial block did not return for a confirmatory block | Retrospective study. Most pts had post-traumatic pain |
| Cohen et al 201078 | 24 pts with axial neck pain | ≥50% pain relief lasting ≥3 hours after a single bupivacaine block. Pts underwent CT after MBB | 38% | FN rate 7% (6 of 84 blocks failed to capture target nerve) | Randomized trial evaluating effect of block volume on outcomes (0.25 vs 0.5 mL), with lower volumes found to be more specific |
CT, computed tomography; FN, false-negative; FP, false-positive; LA, local anesthetic; MBB, medial branch blocks; MVC, motor vehicle collision; pts, patients.