From the FDA Drug Label
Warnings For external use only Do not use ◆ on large areas of the body or on cut, irritated or swollen skin When using this product ◆ use only as directed
The FDA drug label does not answer the question.
From the Research
Topical lidocaine spray is not typically used for epidural steroid injections, as it would only numb the skin surface and not provide adequate anesthesia for the deeper tissues involved in the procedure. For epidural steroid injections, physicians generally use a combination of a long-acting steroid (such as methylprednisolone, triamcinolone, or dexamethasone) mixed with a liquid anesthetic (typically 0.5-1% lidocaine or 0.25-0.5% bupivacaine) that is injected directly into the epidural space 1. The use of local anesthetics like 1% lidocaine solution injected subcutaneously to numb the skin and deeper tissues before the epidural procedure is a common practice.
The most recent and highest quality study, a comparative systematic review and meta-analysis of 3 routes of administration of epidural injections in lumbar disc herniation, provides Level I evidence for local anesthetic and steroids, and Level II evidence for local anesthetic alone for transforaminal and interlaminar approaches 1. This study suggests that epidural injections with local anesthetic and steroids are effective in managing chronic low back and lower extremity pain due to lumbar disc herniation.
Other studies, such as a randomized, controlled, double-blind trial with a two-year follow-up, have also shown that caudal epidural injections of local anesthetic with or without steroids can be an effective therapy for patients with disc herniation or radiculitis 2. Additionally, a randomized, double-blind, active control one-year follow-up study found that the addition of steroid to local anesthetic for epidural injections may provide superior effectiveness in terms of extent and duration of pain relief for managing chronic lumbosacral pain with unilateral lumbosacral radicular pain 3.
However, it is essential to note that topical lidocaine spray is not suitable for epidural steroid injections due to its formulation and sterility concerns. The procedure requires proper sterile technique and specific injectable medications to ensure both patient comfort and safety while delivering the steroid medication to the targeted epidural space around the inflamed spinal nerves.
In terms of potential complications, accidental subdural injection of local anesthetic with steroids can occur during an attempted lumbar epidural injection, resulting in a patchy and unilateral block of greater magnitude than expected, or even a massive motor and sensory block if larger volumes are injected 4. Therefore, it is crucial to recognize and treat such complications early to avoid serious consequences.
In summary, topical lidocaine spray is not recommended for epidural steroid injections, and instead, local anesthetics like 1% lidocaine solution should be used in conjunction with steroids and proper sterile technique to ensure effective and safe pain management for patients with chronic low back and lower extremity pain due to lumbar disc herniation.