The Effects of a Forceful Transforaminal Epidural Steroid Injection on Radicular Pain: A Preliminary Study
1
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background: Lumbar transforaminal epidural steroid injections (TFESIs) are performed to provide symptom relief in patients with radicular pain. Recent articles suggested that injected volume itself have analgesic effects and higher volumes are associated with better outcomes. To date, few studies have been conducted to investigate the effects of volume. Therefore, well-designed controlled studies were necessary to confirm the effect of volume itself on pain relief. The purpose of this study was to examine the effectiveness of a forceful saline injection on lumbar TFESI using non-particulate steroids. Methods: Fifty consecutive patients with lumbar radicular pain were enrolled. The participants were allocated into one of two groups: dexamethasone with volume (Group DV) and dexamethasone alone (Group DO). The volume was delivered by a forceful injection of 5ml of normal saline. The primary end-point for this study was a VAS pain score and modified MacNab score indicating the rate of effectiveness at the four-week follow-up. Results: There were no significant post-procedural VAS differences between two groups (P = .252). The effectiveness rate among the patients was 47.8% in DV group, 34.8% in DO group, measured by modified MacNab score. The difference was not statistically significant (P = .117). Conclusions: A forceful saline injection did not have a significant effect during the treatment of radicular pain. Further studies with greater volumes and with additional techniques would offer a more conclusive perspective.
Abstract
Background: Lumbar transforaminal epidural steroid injections (TFESIs) are performed to provide symptom relief in patients with radicular pain. Recent articles suggested that injected volume itself have analgesic effects and higher volumes are associated with better outcomes. To date, few studies have been conducted to investigate the effects of volume. Therefore, well-designed controlled studies were necessary to confirm the effect of volume itself on pain relief. The purpose of this study was to examine the effectiveness of a forceful saline injection on lumbar TFESI using non-particulate steroids. Methods: Fifty consecutive patients with lumbar radicular pain were enrolled. The participants were allocated into one of two groups: dexamethasone with volume (Group DV) and dexamethasone alone (Group DO). The volume was delivered by a forceful injection of 5ml of normal saline. The primary end-point for this study was a VAS pain score and modified MacNab score indicating the rate of effectiveness at the four-week follow-up. Results: There were no significant post-procedural VAS differences between two groups (P = .252). The effectiveness rate among the patients was 47.8% in DV group, 34.8% in DO group, measured by modified MacNab score. The difference was not statistically significant (P = .117). Conclusions: A forceful saline injection did not have a significant effect during the treatment of radicular pain. Further studies with greater volumes and with additional techniques would offer a more conclusive perspective.
참고문헌 (19)
- Cohen SP, "Epidural steroids: a comprehensive, evidence-based review", Reg Anesth Pain Med, 38, pp.175~200 (2013)
- Manchikanti L, "An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations", Pain Physician, 16, pp.S49~S283 (2013)
- Koc Z, "Effectiveness of physical therapy and epidural steroid injections in lumbar spinal stenosis", Spine (Phila Pa 1976), 34, pp.985~989 (2009)
- Luijsterburg PA, "Effectiveness of conservative treatments for the lumbosacral radicular syndrome : a systematic review", Eur Spine J, 16, pp.881~899 (2007)
- Rabinovitch DL, "Influence of lumbar epidural injection volume on pain relief for radicular leg pain and", or low back pain, 2009, pp.9, 509~517
- Manchikanti L, "Fluoroscopic caudal epidural injections with or without steroids in managing pain of lumbar spinal stenosis: oneyear results of randomized, double-blind, active-controlled trial", J Spinal Disord Tech, 25, pp.226~234 (2012)
- Racz GB, "Pain management", pp.1258~1272 (2011), Elsevier Saunders
- Chun-jing H, "The application of percutaneous lysis of epidural adhesions in patients with failed back surgery syndrome", Acta Cir Bras, 27, pp.357~362 (2012)
- Lee JH, "Comparison of effectiveness according to different approaches of epidural steroid injection in lumbosacral herniated disk and spinal stenosis", J Back Musculoskelet Rehabil, 22, pp.83~89 (2009)
- Benzon HT, "Comparison of the particle sizes of different steroids and the effect of dilution : a review of the relative neurotoxicities of the steroids", Anesthesiology, 106, pp.331~338 (2007)
- Derby R, "Size and aggregation of corticosteroids used for epidural injections", Pain Med, 9, pp.227~234 (2008)
- Furman MB, "Injectate volumes needed to reach specific landmarks in lumbar transforaminal epidural injections", PM R, 2, pp.625~635 (2010)
- Park CH, "Effectiveness of percutaneous transforaminal adhesiolysis in patients with lumbar neuroforaminal spinal stenosis", Pain Physician, 16, pp.E37~E43 (2013)
- Lee JH, "Clinical effectiveness of percutaneous adhesiolysis using Navicath for the management of chronic pain due to lumbosacral disc herniation", Pain Physician, 15, pp.213~221 (2012)
- 조대현, "The Survey of the Patient Received the Epiduroscopic Laser Neural Decompression", The Korean Journal of Pain, 26(1), pp.27~31 (2013), 대한통증학회
- 김성훈, "Clinical Experiences of Transforaminal Balloon Decompression for Patients with Spinal Stenosis", The Korean Journal of Pain, 25(1), pp.55~59 (2012), 대한통증학회
- Heavner JE, "Percutaneous epidural neuroplasty:prospective evaluation of 0.9% NaCl versus 10%NaCl with or without hyaluronidase", Reg Anesth Pain Med, 24, pp.202~207 (1999)
- Koh WU, "Transforaminal hypertonic saline for the treatment of lumbar lateral canal stenosis: a double-blinded, randomized, activecontrol trial", Pain Physician, 16, pp.197~211 (2013)
- El-Yahchouchi C, "The noninferiority of the nonparticulate steroid dexamethasone vs the particulate steroids betamethasone and triamcinolone in lumbar transforaminal epidural steroid injections", Pain Med, 14, pp.1650~1657 (2013)