Cosman & Vu 2005; USA
PEDro = 11
RCT
N=25

Population: Al l subjects with complete SCI; age 46-49 years; 15-25 years post-injury; level of injury: C4-T1
Treatment: intersphincteric anal block with either: a) 300 mg 1% lidocaine or; b) normal saline (placebo) before sigmoidoscopy or anoscopic hemorrhoid ligation procedure.
Outcome Measures: blood pressure

1. The mean maximal systolic blood pressure increase for the lidocaine group (22±14 mmHg) was lower than the placebo group (47±31 mmHg) (p = 0.01) suggesting that AD risk was reduced with lidocaine.

Cosman et al. 2002; USA
PEDro = 9
RCT
N=45

Population: 45 patients (44 male, 1 female) with chronic, complete SCI, injury level of T6 or above, undergoing anoscopy and/or flexible sigmoidoscopies.
Treatment: a) 2% topical lidocaine jelly (n=18) or; b) nonmedicated lubricant (control, n=32) just prior to the procedure.
Outcome Measures: blood pressure

1. Topical lidocaine had no significant effect on mean maximal systolic blood pressure (increased 35±25 mmHg in the lidocaine group vs. 45± 30 mmHg in the control group).
2. Greater SBP increase with anoscopic procedure compared to sigmoidoscopic procedures (49±29 vs. 25± 20 mmHg, respectively).

Furusawa et al. 2009;
Japan
PEDro = 8
RCT
N = 25

Population: 25 cervical SCI subjects (22 men, 3 women); level of injury: C4-C7, time post-injury was 23.4 + 36.4 (range 3-172) months.
Treatment: 10mL of 2% Lidocaine treatment group (placebo jelly for control group); both groups then underwent digital bowel stimulation to initiate and augment stool flow
Outcome Measures: blood pressure; heart rate; symptoms of autonomic dysreflexia

1. 10 subjects in the control group reported symptoms of AD, compared to 4 patients in the treatment group
2. Systolic blood pressure was significantly lower in treatment group, compared to the control
3. No significant difference in diastolic blood pressure or heart rate