Clinical Outcome and Flouroscopic Comparison of Two Different Approaches of Epidural Steroid in Low Backache Patients

Sandhu, Nayyaamat; Gupta, Rajesh; Singh, Swati; Aujla, K; Kaur, Maninder; Bindra, Tripat Kaur

doi:10.14260/jemds/2014/2568

Cited by 2 publications

(2 citation statements)

References 17 publications

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“…Following the full‐text screening, we excluded 84 items that were ineligible. Finally, we included 33 papers 16,18,20,21,25–53 that matched our inclusion criterion (27 articles were suitable for analysis) 16,18,20,21,25–37,39–42,44,45,48,49,51,52 . There were 24 parallel RCTs, five cohort studies, and four case–control studies among the 33 papers.…”

Section: Resultsmentioning

confidence: 99%

A systematic review and network meta‐analysis comparing different epidural steroid injection approaches

Mahmoud,

Shawky,

Farghaly

et al. 2023

Pain Practice

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BackgroundLow back pain (LBP) and lumbosacral radiculopathy are frequent disorders that cause nerve root injury, resulting in a variety of symptoms ranging from loss of sensation to loss of motor function depending on the degree of nerve compression.ObjectivesThe goal of this study was to investigate the effectiveness of various epidural injection procedures in adult LBP patients.Study DesignSystematic review and network meta‐analysis.SettingEgypt.MethodsPubMed, Scopus, Web of Science, Cochrane Database, and Embase were used to conduct an electronic literature search. We included RCTs, cohorts, case controls, patients 30 years old with a clinical presentation of low back pain, and comprehensive data on the effects of the intervention on patients with lumbosacral radicular pain who got epidural steroid injections via various techniques. Only papers written in English were eligible.ResultsOur analysis showed that parasagittal intralaminar (PIL) was the most effective approach in decreasing VAS (0–10) in the short term (< 6 months) (MD = −1.16 [95% CI −2.04, −0.28]). The next significant approach was transforaminal (TF) (MD = −0.37 [95% CI −1.14, −0.32]) in the long term; TF was the most effective approach (MD = −0.56 [95% CI −1, −0.13]). According to VAS (0–100) in the short term (< 6 months), our analysis showed an insignificant difference among the injection approaches and in the long term; TF was the most effective approach (MD = −24.20 [95% CI −43.80, −4.60]) and the next significant approach was PIL (MD = −23.89 [95% CI −45.78, −1.99]).LimitationsThe main limitations are the heterogeneity encountered in some of our analyses in addition to studies assessed as high risk of bias in some domains.ConclusionTF was the most effective steroid injection approach. In decreasing VAS for short‐term PIL and TF were the most significant approaches, but TF was the most effective approach in decreasing VAS for the long term. Also, TF was the most effective approach in decreasing ODI for the long term.

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Section: Resultsmentioning

confidence: 99%

A systematic review and network meta‐analysis comparing different epidural steroid injection approaches

Mahmoud,

Shawky,

Farghaly

et al. 2023

Pain Practice

View full text Add to dashboard Cite

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“…Many approaches, such as midline, parasagittal, transforaminal, and caudal have been used for epidural steroid injections and all proved advantageous in relieving pain of chronic LBA. 7,8 However, in patients with "red flag" signs or those depicting severe mechanical origin of LBA, often multiple steroid injections are required which associated with longlasting side effects. Thus, a research on adjuvants has been started that could enhance the efficacy of epidural steroids and reduce the number of repeat blocks in these patients.…”

Section: Discussionmentioning

confidence: 99%

Prospective Placebo-controlled Randomized Trial to compare the Efficacy of Ketamine as an Adjuvant to Epidural Steroids in preventing Repeat Blocks in Chronic Low Back Pain

Singh¹,

Bawa²,

Mahajan³

et al. 2017

AMEI's Current Trends in Diagnosis &Amp; Treatment

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Introduction Low back pain behaves as a “silent epidemic,” ranking first among complications related to work. Often there is a large gap between a patient's desired pain reduction and the minimum percentage of improvement that would make a treatment worthwhile. Consequently, debate continues as to the value of epidural steroid injections, supremacy of one adjuvant over others, various doses, and concentrations in optimizing pain management. Objective To compare the efficacy of ketamine vs normal saline as an adjuvant to epidural steroids in chronic low back pain. Study design Randomized prospective placebo-controlled study. Materials and methods The study was conducted on 60 patients of age group 18 to 70 years having chronic lower backache with or without radiculitis of minimum 3 months duration and having no relief with conventional treatment. The patients selected were randomly allocated into two groups of 30 patients each: Group I (n = 30) given triamcinolone 40 mg, preservative-free ketamine 30 mg (0.6 mL) made up to 6 mL solution with 0.25% bupivacaine and group II (n = 30) given 0.6 mL normal saline instead of ketamine. Outcome measures The primary outcome measured was number of patients requiring repeat blocks and number of repeat blocks administered in 3 months. Other outcome measures were functional improvement quantified by visual analog scale (VAS) and Oswestry disability index (ODI) as well as improvement in psychological status by depression scoring, all taken at 2 weeks interval for 3 months. The periprocedural complications were also noted at the end of the study. Results In managing lumbar radicular pain with lumbar epidural steroid injection (LESI), ketamine's role as an adjuvant proved to be advantageous for long-term relief by its inhibition of dorsal horn “wind up” phenomenon through N-methyl-D-aspartate (NMDA) receptor antagonism, thus reducing frequency of repeat blocks in group II (ketamine). Conclusion Thus to conclude, ketamine's advantage as a drug that prolongs pain relief from LESI is an avenue for further research and promises a bright future in the field of interventional pain medicine. How to cite this article Gupta R, Bawa C, Singh S, Mahajan L, Kaur B, Kaur T. Prospective Placebo-controlled Randomized Trial to compare the Efficacy of Ketamine as an Adjuvant to Epidural Steroids in preventing Repeat Blocks in Chronic Low Back Pain. Curr Trends Diagn Treat 2017;1(1):15-21.

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Clinical Outcome and Flouroscopic Comparison of Two Different Approaches of Epidural Steroid in Low Backache Patients

Cited by 2 publications

References 17 publications

A systematic review and network meta‐analysis comparing different epidural steroid injection approaches

A systematic review and network meta‐analysis comparing different epidural steroid injection approaches

Prospective Placebo-controlled Randomized Trial to compare the Efficacy of Ketamine as an Adjuvant to Epidural Steroids in preventing Repeat Blocks in Chronic Low Back Pain

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