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New article from Austria

Posted by Jan R. on 4/28/05 at 09:44 (173868)

Influence of Local Anesthesia and Energy Level on the Clinical Outcome of Extracorporeal Shock Wave-Treatment of Chronic Plantar Fasciitis.

Z Orthop Ihre Grenzgeb. 2005 Jan;143:240-246

Labek G, Auersperg V, Ziernhold M, Poulios N, Bohler N.

e-mail: (email removed)

BACKGROUND: The efficacy of low energy extracorporeal shock wave treatment (ESWT) for chronic plantar fasciitis is discussed controversially. It is unclear whether the simultaneous application of local anesthesia (LA) interferes with clinical outcome.

METHODS: 60 patients with a chronic plantar fasciitis were enrolled in a triple-arm (20 patients per group), prospective randomized and observer-blinded pilot trial. The patients were randomly assigned to receive either active ESWT without LA (;3 x 1 500 shocks, total energy flux density [EFD] per shock 0.09 mJ/mm(2) [Group A]), ESWT with LA (3 x 1 500 shocks, EFD 0.18 mJ/mm(2) per shock [Group B]) or ESWT with LA (3 x 1 500 shocks, EFD 0.09 mJ/mm(2) [Group C]). Main outcome measures were: pain during first stepps in the morning (measured on a 0-10 point visual analogue scale) and number of patients with > 50 % reduction of pain and no further therapy needed, measured at 6 weeks after the last ESWT.

RESULTS: Group A improved in the VAS from 6.4 (SD: 1.7) to 2.2 (SD: 2.6) points, group B from 6.7 (SD: 1.5) to 4.1 (SD: 2.4) points, group C from 6.2 (SD: 1.6) to 3.8 (SD: 2.5) points. A reduction of pain of at least 50 % was achieved in 60 % of group A, in 36 % of group B and in 30 % of group C. Group A without LA showed a significantly higher improvement in the VAS and subjective evaluation than groups B (p = 0.007) and C (p = 0.016).

CONCLUSION: At 6 weeks success rates after low-energy ESWT with local anesthesia were significantly lower than after identical low-energy ESWT without local anesthesia. Higher energy levels could not balance the disadvantage of this effect. LA significantly influenced the clinical results after low energy ESWT in a negative way. Blinding patients by LA in ESWT studies must therefore be considered a systematic error in study design.

Re: New article from Austria

DriverWilde on 4/28/05 at 09:58 (173869)

Any Docs out there care to comment about the time period? Seems strange that the study is evaulated at 6 weeks, when every other study out there is evaluated at 12.

-DW

Re: New article from Austria

elvis on 4/28/05 at 23:24 (173904)

Driver........It looks to me that this study evaluated only one treatment with low energy ESWT. 6 weeks would seem like an adequate time period. From what I've read the low energy (Sonocur) is administered every week or 2 for 3 treatments. So if they were analyzing one low energy treatment then 6 weeks would appear to be reasonable.

Re: New article from Austria

Dr. Z on 4/28/05 at 23:52 (173905)

Where does it say that they used only one ESWT treatment. It looks like three low energy treatments and then six weeks after the last low eswt treatment was the protocol. Maybe Dr. Rompe could help you with the answer

Re: New article from Austria

john on 4/29/05 at 09:14 (173913)

Elvis,

Take a look at the abstract. It says

Group A: Three treatments of 1500 shocks for each treatment with total energy flux density per shock of 0.09mj/mm2 without local anesthesia.

Group B: Three treatments of 1500 shocks for each treatment with total energy flux density per shock of 0.18mj/mm2 with local anesthesia.

Group C: Same as Group A except with local anesthesia.

Re: New article from Austria

elvis on 4/29/05 at 12:00 (173923)

ooops..........DrZ and john.you're correct. Hey, it was late!

Re: New article from Austria

Ed Davis, DPM on 4/30/05 at 12:05 (173974)

Jan:
A major point of confusion among patients (and sometimes clinicians) is the proper definition of local anesthesia and how it differs from regional anesthesia. Local anesthesia involves placing a solution of an local ansthetic in the body part to be treated. Regional anesthesia, more commonly used, involves the placement of a 'local' anesthetic such as lidocaine away from the treated area so the region about the area to be treated is numbed.
Ed

Re: New article from Austria

Ed Davis, DPM on 4/30/05 at 12:07 (173975)

Local anesthesia should never be used either for high nor low energy ESWT becasue a 'damping effect' is set up in the tissue.
Ed

Re: New article from Austria

Dr. Z on 4/30/05 at 12:11 (173976)

Ed,

While I agree with you. Are there any studies showing decrease effects with local anesthesia and HIGH energy ESWT. We use a regional anesthetic block which is different then a local anesthetic.