Epidural Local Anesthetic Plus Corticosteroid for the Treatment of Cervical Brachial Radicular Pain: Single Injection Versus Continuous Infusion

Pasqualucci, Alberto; Varrassi, Giustino; Braschi, A.; Peduto, V. A.; Brunelli, Andrea; Marinangeli, Franco; Gori, Fabio; Colò, Francesca; Paladini, Antonella; Mojoli, Francesco

doi:10.1097/ajp.0b013e318074c95c

Cited by 123 publications

(152 citation statements)

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“…37 Furthermore local anesthetic agents can also exert beneficial effects by curtailing pain-induced neuronal sensitization and release of neurotransmitters involved in pain pathways. [38][39][40][41] Alternately, administration of corticosteroids in the epidural space is thought to reduce inflammatory edema of the injured nerve root, 42 decrease sensitization of the dorsal horn neurons, 43 and suppress the transmission of nociceptive C fibres. 44 In clinical practice, both agents are often combined.…”

Section: Epidural Blockadementioning

confidence: 99%

Lumbar spinal stenosis: a brief review of the nonsurgical management

Tran

Duong

Finlayson

2010

Can J Anesth/J Can Anesth

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Because of their variable quality, published RCTs can provide only limited evidence to formulate recommendations pertaining to the nonsurgical treatment of LSS. In this narrative review, no study was excluded based on factors such as sample size justification, statistical power, blinding, definition of intervention allocation, or clinical outcomes. This aspect may represent a limitation as it may serve to overemphasize evidence derived from "weaker" trials. Further well-designed RCTs are warranted.

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Section: Epidural Blockadementioning

confidence: 99%

Lumbar spinal stenosis: a brief review of the nonsurgical management

Tran

Duong

Finlayson

2010

Can J Anesth/J Can Anesth

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“…In general, cervical epidural injections are not recommended for axial neck pain, but they are considered to be reasonable for disc herniation with radiculitis and spinal stenosis 6,10-14,16-18,35-37. A single report of a one year follow-up of discogenic neck pain after excluding cervical facet joint pain in 120 patients without disc herniation or radiculitis showed a primary outcome of significant pain relief and improvement in functional status (≥ 50%) in 72% of patients in Group I receiving local anesthetic and 68% in Group II receiving local anesthetic and steroids.…”

Section: Introductionmentioning

confidence: 99%

Two-Year Follow-Up Results of Fluoroscopic Cervical Epidural Injections in Chronic Axial or Discogenic Neck Pain: A Randomized, Double-Blind, Controlled Trial

Manchikanti

Ka²,

Pampati³

et al. 2014

Int. J. Med. Sci.

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Study Design: A randomized, double-blind, active-controlled trial.Objective: To assess the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids for the management of axial or discogenic pain in patients without disc herniation, radiculitis, or facet joint pain.Summary of Background Data: Cervical discogenic pain without disc herniation is a common cause of suffering and disability in the adult population. Once conservative management has failed and facet joint pain has been excluded, cervical epidural injections may be considered as a management tool. Despite a paucity of evidence, cervical epidural injections are one of the most commonly performed nonsurgical interventions in the management of chronic axial or disc-related neck pain.Methods: One hundred and twenty patients without disc herniation or radiculitis and negative for facet joint pain as determined by means of controlled diagnostic medial branch blocks were randomly assigned to one of the 2 treatment groups. Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL), whereas Group II patients received 0.5% lidocaine, 4 mL, mixed with 1 mL or 6 mg of nonparticulate betamethasone.The primary outcome measure was ≥ 50% improvement in pain and function. Outcome assessments included numeric rating scale (NRS), Neck Disability Index (NDI), opioid intake, employment, and changes in weight.Results: Significant pain relief and functional improvement (≥ 50%) was present at the end of 2 years in 73% of patients receiving local anesthetic only and 70% receiving local anesthetic with steroids. In the successful group of patients, however, defined as consistent relief with 2 initial injections of at least 3 weeks, significant improvement was illustrated in 78% in the local anesthetic group and 75% in the local anesthetic with steroid group at the end of 2 years. The results reported at the one-year follow-up were sustained at the 2-year follow-up.Conclusions: Cervical interlaminar epidural injections with or without steroids may provide significant improvement in pain and functioning in patients with chronic discogenic or axial pain that is function-limiting and not related to facet joint pain.

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“…The occurrence of levator scapulae syndrome is attributed to the excitement of the free nerve endings inside the muscle fascia. Recently, studies have reported that interfacial block, relieved myofascial pain by reducing the excitability of these nerve endings [10][11][12].…”

Section: Discussionmentioning

confidence: 99%