R. Harden

Poster 378 Development of a Severity Score for Complex Regional Pain Syndrome (CRPS)

Disclosures: F. V. Borges, No Disclosures. Objective: Review the potential role of local anesthetics and injections to decrease pain in knee osteoarthritis. Design: MEDLINE database (PubMed) and Cochrane Library were screened up to January 2012. The search strategy used was based on structured questions as PICO (The initials “Patient,” “Intervention,” “Control,” “Outcome”): “Knee Osteoarthritis” and “nerve block” OR “Bupivacaine” OR “Lidocaine” OR “ropivacaine” [Supplementary Concept] OR “Anesthesia”, Spinal. Studies were included for adults diagnosed with knee osteoarthritis, randomized controlled trials (RCTs), published in any date, in humans, in the English language and using intra-articular or periarticular injections. Methodological quality was assessed by the Jadad and Van Tulder scores. Setting: Clinical research center. Main Outcome Measures: Pain, function and quality of life related outcomes. Results: We retrieved 89 citations and included 10 RCTs, all low risk of bias, with 873 patients, aged 63.9 years. Intra-articular injection of bupivacaine 0.25-0.5% provides similar results than hyaluronic acid, morphine or saline. Superior short term, but not long term improvement on pain and function is achieved with the association of methylprednisolone (1mL, 40mg) and lidocaine 1% (9mL) than lidocaine 1% (9mL) and saline 0.9% (1mL). The effect of multimodal intra-articular injection of bupivacaine 0.5%, morphine 10mg, methylprednisolone 40mg and epinephrine is still controversial. Periarticular injection of bupivacaine 2mg/mL, fentanyl and methylprednisolone is more beneficial than no infiltration. Intradermal injections of lidocaine 1% at periarticular trigger points provide similar results than injections of sterile saline at periarticular trigger points. The association of lidocaine 1% injections intraarticularly (10mL) and at soft tissues (5-10mL) is similar to intraarticular injection of triancinolone (40mg) and lidocaine. Conclusions: The benefits of most local anesthetics and injections are similar to morphine, hyaluronic acid and placebo. Efficacy of the association of medications is still controversial and should be further investigated.

Poster 293 Facial Diplegia and Paresthesias as a Rare Guillain-Barré Variant: A Case Report

found between PVR and ALS-FRS with a R, 0.95 and P .025. A linear correlation also was noted between PVR and lower limbs Ashworth Scale. Conclusions: Urinary retention is common in ALS. Urologic evaluation is indicated in patients with ALS and with prominent spasticity. Bladder disorders in subjects with ALS subjects be treated with therapies aimed at improving pelvic floor muscles activity (strength and spasticity). In cases in which retention is documented, self-intermittent catheterization should be considered.

Poster 314 Complex Regional Pain Syndrome Severity Score: Development of A Clinical Tool For Monitoring Disease Evolution

Disclosures: C. J. Moon, none. Objective: To compare the accessibility and the effect of retrodiskal (RD) approach of lumbar transforaminal epidural block with conventional subpediular (SP) approach in severe foraminal stenosis. Design: Case control study. Setting: Tertiary hospital. Participants: Patients with L5 radiculopathy who were planned to receive transforaminal epidural block were consecutively included as subjects and were randomly divided into the RD group and the SP group. Interventions: A mixture of triamcinolone 20 mg and 0.5% lidocaine 1.5 mL was injected in both groups after confirming a contrast spread by retrodiskal approach through L5-S1 foramen at intervertebral disk level on prone position 40°-45° off the AP axis. Main Outcome Measures: The diffusion pattern of contrast dye, easiness of needle’s target attainment, and visual analog scale (VAS), which had been recorded before and after 2 weeks of the treatment, of the 2 groups. Results: There were no differences in subjects’ demographic data and early VAS of the RD (n 13) and SP (n 8) groups, which were 6.9 0.8 and 6.6 0.7, respectively. After 2 weeks of treatment, VAS of the RD group was 2.4 0.9, much lower than 3.8 0.7 of the SP group (P .05). We failed to insert the needle tip into the target point in 3 patients of the SP group due to severe foraminal stenosis. In the SP group, 2 patients had nerve root irritation symptoms during the procedure. In 10 cases of the RD group and 4 cases of the SP group, contrast dye diffused to the proximal nerve root, and, in 5 cases of the RD group and 3 cases of SP group, contrast dye diffused to the distal nerve root, but there was no significant difference between the 2 groups except for failed approach. Conclusions: The RD approach of lumbar transforaminal epidural block might be a useful technique, especially in the case of severe foraminal stenosis.

Poster 391: Vasomotor and Sudomotor Responses in Spinal Cord Injury (SCI) Patients

Disclosures: I. Choi, None. Objective: To investigate the significance of urodynamic findings in spinal cord injury (SCI) patients. Design: Case study. Setting: Tertiary-based hospital in Republic of Korea. Participants: 109 SCI patients (86 men, 23 women; age 43.0 12.7 years; duration of disease 18.1 15.9 days; 51 complete injury, 58 incomplete injury; 43 cervical lesion, 51 thoracic lesion, 5 lumbar lesion, 10 cauda equina lesion) admitted to our rehabilitation unit from January 2004 to June 2009. Interventions: Urodynamic study; ice and warm water tests. Main Outcome Measures: Voiding sense, maximal cystometric capacity, compliance, and reflex of detrusor muscle in filling phase; maximal detrusor pressure and urethral sphincter pressure in voiding phase; infusion volume. Results: (1) According to the anatomical classification of neurogenic bladder, neurologic level of injury was above T10 in 78, between T10-L2 in 20, and below L2 in 11 patients; (2) the lower the level of injury was, the higher the compliance of detrusor muscle was and the lower its reflex was, but it was not statistically significant (P .05). There was no significant correlation between the level of injury and the activity of detrusor muscle (P .142); (3) In the patients whose level of injury were above T10, no significant differences were observed in the tonicity, reflex, and activity of detrusor muscle according to the completeness (P .05); (4) there was a significant correlation between the reflex of detrusor muscle and the infusion volume in ice water test (r 0.346, P .045); and (5) no significant difference was observed in the tonicity, activity, and reflexivity of detrusor muscle according to the existence of voiding sense (P .05). Conclusions: As urodynamic findings according to the anatomical classification of neurogenic bladder are not consistent in SCI, it is necessary to apply the patientspecific bladder management program based on urodynamic findings. Poster 390 Validation of the Spanish Version of the King’s Health Questionnaire for Evaluating Quality of Life Related to Urinary Incontinence in Patients With Spinal Cord Injury. Georgia Romero Cullere, MD (Fundació Althaia, Manresa, Spain); Joan Conejero, MD; Miguel Angel Gonzalez Viejo, MD, PhD; Judith Sanchez Raya, MD.