Comparison of Clinical Outcomes of Different Rates of Infusion in Caudal Epidural Steroid Injection: A Randomized Controlled Trial

Abstract

To compare the clinical outcomes between patients with lumbosacral radiculopathy that received caudal epidural steroid injection (CESI) at injection rates of 40 mL/min (fast rate) and 20 mL/min (slow rate) and to identify the complications associated with these different CESI rates. Overview of Literature: CESI is widely used for chronic low back pain with lumbar radiculopathy. However, the influence of CESI rates on clinical outcomes has not been well studied. Methods: Ninety patients were randomized into two CESI groups. Two patients did not complete the study. Eighty-eight were included in the final analysis: 44 patients were in the fast infusion group, and 44 patients were in the slow infusion group. Intragroup and intergroup comparisons were conducted with regard to the Visual Analog Scale (VAS), Roland 5-point pain scale, standing tolerance test, walking tolerance test, and patient satisfaction scale at pre-injection, 2 weeks, 6 weeks, and 12 weeks post-injection. Complications associated with the different rates were recorded. Results: Both groups demonstrated clinical improvement in all parameters, except for VAS, after injection. There were no statistically significant differences in any outcomes at each time point between the two groups. One patient in the fast rate group and no patients in the slow rate group experienced nausea and vomiting after injection (p=0.320). Eight patents in the fast rate group and two patients in the slow rate group experienced pain at the injection site (p=0.044). Conclusions: Although there were no significant differences between injection rates in the short-term clinical improvement outcomes, the fast injection rate group experienced more pain at the injection site, suggesting that the use of the slow injection rate may be considered.

Lumbar Spinal Stenosis: Review Update 2022

“…Peripheral neuropathy caused by diabetes, alcoholism, or drug use should be suspected when there is paresthesia. To identify blood flow obstructions and rule out lower-extremity edema and varicose veins, the dorsum of the foot and popliteal artery should be palpated [19]. Furthermore, it should be separated from signs of lesions in the lower extremities, such as hip and knee lesions [3,[20][21][22][23][24].…”

“…An intermediate type of treatment between nonsurgical options and epidural steroid injections. According to several studies, between 50% and 87% of patients have short-term (around 3 weeks) symptom alleviation using epidural steroid injection therapy [2,19,[41][42][43][44]. Epidural steroid injection is indicated for acute radiating pain and nervous claudication that are interfering with daily life despite pain relievers and rest, which are expected to improve symptoms [45].…”

Novel approach of ultrasound-guided lateral recess block for a patient with lateral recess stenosis: A case report

“…Due to the close proximity within the spinal canal, stenosis in this region always leads to low back pain, numbness, neurogenic claudication and even urination-defecation impairment[ 2 ], which often affect mobility and walking ability, leading to a reduction in patients’ quality of life[ 3 , 5 ]. Lateral recess block (LRB) is commonly used for this condition due to its immediate analgesic effect in approximately 50%–87% of patients[ 6 , 7 ]. To improve efficacy and accuracy, computed tomography (CT), X-ray, and ultrasound guidance are widely used in minimally invasive therapy[ 8 ].…”