Comparison of the efficacy of saline, local anesthetics, and steroids in epidural and facet joint injections for the management of spinal pain: A systematic review of randomized controlled trials

Abstract

Background:The efficacy of epidural and facet joint injections has been assessed utilizing multiple solutions including saline, local anesthetic, steroids, and others. The responses to these various solutions have been variable and have not been systematically assessed with long-term follow-ups.Methods:Randomized trials utilizing a true active control design were included. The primary outcome measure was pain relief and the secondary outcome measure was functional improvement. The quality of each individual article was assessed by Cochrane review criteria, as well as the criteria developed by the American Society of Interventional Pain Physicians (ASIPP) for assessing interventional techniques. An evidence analysis was conducted based on the qualitative level of evidence (Level I to IV).Results:A total of 31 trials met the inclusion criteria. There was Level I evidence that local anesthetic with steroids was effective in managing chronic spinal pain based on multiple high-quality randomized controlled trials. The evidence also showed that local anesthetic with steroids and local anesthetic alone were equally effective except in disc herniation, where the superiority of local anesthetic with steroids was demonstrated over local anesthetic alone.Conclusion:This systematic review showed equal efficacy for local anesthetic with steroids and local anesthetic alone in multiple spinal conditions except for disc herniation where the superiority of local anesthetic with steroids was seen over local anesthetic alone.

Management for failed back surgery syndrome: three-in-one procedure versus percutaneous spinal fixation alone

“…In support of this cut-off point for evaluation of procedural success; Avellanal et al 18 defined treatment success as ≥ 50% long-term pain relief maintained during the first year of follow-up. Also, Manchikanti et al 35 documented that the summary measure for pain was ≥ 50% reduction of pain in at least 50% of patients, or at least a threepoint decrease in pain scores; for disability scores the summary measure was ≥ 50% reduction in disability in at least 40% of …”

Some Aspects of Diagnosing and Treatment of Nonspecific Back Pain

“…Длительная терапия глюкокортикоидами может привести к отклоне-ниям в работе эндокринной и пищеварительной систем, а также к нарушениям обмена веществ. Тем не менее глю-кокортикоиды были и остаются наиболее распространен-ными (после анестетиков) препаратами для интервенци-онной терапии боли, эффективность которых доказана в 31 рандомизированном клиническом исследовании [17]. Локальные инъекции ГКС являются важным элементом комплексной терапии хронической боли в спине.…”

Letter to the Editor: Alternative approach in Type II hangman fractures

“…Consequently, it may be more appropriate to consider literature related to the effectiveness of epidural injections in disc herniation rather than spinal stenosis only, 7,12,14 of alternative approaches for transforaminal epidural injections, 1,15,16 of other routes of administration including caudal and lumbar interlaminar routes, 13,14 and finally of local anesthetic alone without steroids.…”

“…However, they, 17 like Kraeutler et al, 5 have relied heavily on a single flawed randomized trial with inappropriate references 3,8 and have omitted a multitude of studies performed with what we believe is a more relevant design. [9][10][11]13 Transforaminal epidural injections are associated with significant complications, including paraplegia, especially when they are performed utilizing the safe triangle approach with particulate steroids. 1,15,16 These complications can be avoided by using an infraneural approach.…”