Significance in Rehabilitation

Physical therapists may encounter the use of local anesthetics in several patient situations because of their various clinical applications. For example, therapists may be directly involved in the topical or transdermal administration of local anesthetics. As discussed earlier, repeated topical application of local anesthetics may help produce long-term improvements in motor function in patients with skeletal muscle hypertonicity, so therapists may want to consider incorporating topical anesthetics into the treatment of certain patients with CNS dysfunction. Therapists may also administer local anesthetics transdermally, using the techniques of iontophoresis and phonophoresis. Agents such as lido-caine can be administered through this method for the treatment of acute inflammation in bursitis, tendinitis, and so on. 

Therapists may also be working with patients who are receiving local anesthetic injections for the treatment of CRPS/RSDS. Since these patients often receive a series of anesthetic injections, therapists may want to schedule the rehabilitation session immediate- 

Finally, therapists may work with patients who are receiving central neural blockade in the form of an epidural or spinal injection. These procedures are common during natural and caesarean childbirth and in some other surgical procedures. Administration of local anesthetics into the spaces around the spinal cord are also used to treat individuals with severe and chronic pain—that is, patients recovering from extensive surgery, patients who have cancer, or patients with other types of intractable pain. In these situations, therapists may notice that an indwelling catheter has been placed in the patient s epidural or subarachnoid space to allow repeated or sustained administration of the spinal anesthesia. 

In situations where central neural blockade is used, therapists should be especially aware that sensation might be diminished below the level of epidural or spinal administration. Decreased sensation to thermal agents and electrical stimulation will occur when the central block is in effect.10 Likewise, motor function may be affected in the lower extremities when local anesthetics are administered spinally or epidural-ly.10 Hence, therapists should test sensation and motor strength before applying any physical agents or attempting ambulation with patients who have received some type of central neural blockade using a local anesthetic. 

Brief History. R.D. is a 35-year-old man who developed pain in his right shoulder after spending the weekend chopping firewood. He was examined by a physical therapist and evaluated as having supraspinatus tendinitis. Apparently, this tendinitis recurred intermittently, usually after extensive use of the right shoulder. During past episodes, the tendinitis was resistant to treatment and usually took several months to resolve. 

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