Response to “Clinical recommendations for use of lidocaine lubricant during bowel care after spinal cord injury prolong care routines and worsen autonomic dysreﬂexia: results from a randomized clinical trial” – the authors reply

Spinal Cord, 2021 · DOI: https://doi.org/10.1038/s41393-021-00716-3 · Published: October 22, 2021

Spinal Cord Injury Neurology Gastroenterology

Simple Explanation

The authors respond to a critique of their study on lidocaine lubricant during bowel care for individuals with spinal cord injury (SCI). They reaffirm the rigor and clinical relevance of their work, which examined at-home bowel care experiences. The authors clarify their choice of peak systolic arterial pressure (SAP) as the primary outcome measure, explaining that changes relative to baseline could be problematic due to potential autonomic dysreflexia (AD) present at baseline. The authors defend their conclusion that lidocaine is not beneficial, stating that lidocaine not only failed to improve AD but also impaired reflexive defecation and bowel emptying, leading to longer bowel care times.

Study Duration

Not specified

Participants

Individuals living with spinal cord injury

Evidence Level

Level 1, Randomized clinical trial (referenced)

Key Findings

1
Lidocaine did not provide any benefit in terms of severity of AD during bowel care based on all metrics of AD classification.
2
The peak systolic arterial pressure (SAP) was significantly higher, and the overall AD burden was significantly worse with lidocaine use.
3
Lidocaine had the side effect of impairing reflexive defecation and bowel emptying, leading to an increased time to complete bowel care.

Research Summary

The authors' study examined the utility of topical lidocaine lubricant for the amelioration of autonomic dysreflexia (AD) during bowel care in individuals living with spinal cord injury (SCI). The response emphasizes that, based on their data, lidocaine impairs reflex defecation, resulting in longer and more difficult care procedures that provoke more severe AD. The authors conclude that lidocaine lubricants should not be recommended for routine bowel care in individuals with SCI, as it hampered care routines, impaired defecation, and worsened AD.

Practical Implications

Challenging Current Recommendations

The findings suggest that current recommendations for using lidocaine during at-home bowel care for individuals with SCI should be questioned.

Re-evaluation of Bowel Care Practices

Clinicians and individuals with SCI should re-evaluate the use of lidocaine lubricant as a routine part of bowel care, considering potential negative impacts on AD and bowel emptying.

Need for Alternative Strategies

There is a need to explore and develop alternative strategies for managing AD and improving the efficiency and comfort of bowel care routines for people with SCI.

Study Limitations

1
The original study had a small sample size, though it met sample size calculation requirements for the primary outcome measure.
2
The study focused on topical lidocaine use, and its findings may not be generalizable to injected lidocaine anal blocks.
3
The study examined AD responses during routine bowel care, which may differ from AD responses to controlled bowel stimuli where defecation is not the outcome.

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