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A Randomized Controlled Trial of the Reciprocating Procedure Device for Intraarticular Injection of Corticosteroid
ARTHUR D. BANKHURST, SHARON E. NUNEZ, HILDA T. DRAEGER, SHARON C. KETTWICH, LAWRENCE G. KETTWICH, and WILMER L. SIBBITT Jr ABSTRACT. Objective. Injection of intraarticular corticosteroid remains an important therapy for inflammatory arthritis. In a randomized controlled trial we compared the new reciprocating procedure device (RPD) to the traditional syringe for injection of intraarticular corticosteroid. Methods. One hundred fifty-four intraarticular corticosteroid injection procedures were randomized to the conventional syringe or the RPD. Using the syringe or RPD, the needle was introduced into the joint, any effusion that was present was aspirated, and the corticosteroid (methylprednisolone acetate) was injected. Outcome measures included patient pain measured by visual analog scale (VAS pain), procedure duration, operator satisfaction, complications, and immediate and delayed response to the injected medication. Results. The RPD reduced pain scores by 49% (RPD VAS pain score: 2.40 ± 2.17; conventional syringe VAS pain score: 4.73 ± 3.39; p < 0.001), reduced procedure time by 31% (RPD: 1.28 ± 1.08 min, conventional syringe: 1.86 ± 1.26; p < 0.01), and improved physician satisfaction with the joint procedure device by 63% (RPD visual analog satisfaction scale score: 9.12 ± 0.80, conventional syringe 5.59 ± 1.28; p < 0.001). Fifty-five percent (43/78) of patients experienced moderate to severe pain (VAS pain ≥ 5) with the conventional syringe, while 17% (13/76) experienced moderate to severe pain with the RPD. The same beneficial response was present when intermediate or large joints were analyzed separately. Longterm outcomes were equivalent. Conclusion. When a conventional syringe is used for corticosteroid injection, many patients experience significant procedural pain. The RPD significantly reduces patient pain, reduces procedure time, and improves operator satisfaction. The RPD is superior to the traditional syringe for injection of intraarticular corticosteroid. (First Release Dec 1 2006; J Rheumatol 2007;34:187–92) Key Indexing Terms:
SYRINGE From the Division of Rheumatology, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA. Dr. Sibbitt is the inventor of the reciprocating procedure device, which is owned by the University of New Mexico. A.D. Bankhurst, MD; H.T. Draeger, MD; S.E. Nunez, MD; S.C. Kettwich, BS; L.G. Kettwich, BS; W.L. Sibbitt Jr, MD, Professor, Department of Internal Medicine and Department of Neurology. Address reprint requests to Dr. W.L. Sibbitt, Internal Medicine and Neurology, 5th Fl ACC, University of New Mexico Health Sciences Center, Albuquerque, NM 87131. E-mail: wsibbitt@salud.unm.edu Accepted for publication September 8, 2006.
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