scholarly journals Methylprednisolone Dosage in Lumbar Epidural Steroid Injections: A Retrospective Analysis of Efficacy in Pain Relief

2020 ◽  
pp. 25-32
Author(s):  
Calvin Rong Chen
Keyword(s):  
Pain Relief ◽  
Adverse Effects ◽  
Retrospective Chart Review ◽  
Similar Efficacy ◽  
Pain Scale ◽  
Pain Clinic ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Number Of Patients ◽  
Epidural Steroid

Background: Epidural injections have been used for pain relief since the 1880s. Corticosteroids are antiinflammatory medications that can alleviate pain, but also have harmful systemic adverse effects. Literature regarding methylprednisolone dosage efficacy is limited. Objectives: To determine the lowest effective dose of methylprednisolone in a lumbar epidural steroid injection (LESI) for maximal pain relief without exposing patients to adverse events caused by steroid use. Study Design: Retrospective chart review. Setting: Outpatient interventional pain clinic at an academic center. Methods: Adults (n = 133), aged 18 to 85 years, with low-back pain and radicular symptoms treated with LESI from August 2011 to November 2015. Patients who received prior cervical epidural steroid injections were excluded. Interventions were LESI with methylprednisolone 40 mg, 80 mg, or 120 mg. Main outcome measures showed change in pain score using a numeric pain scale (NPS; 0 = no pain, 10 = excruciating pain), and patient’s self-reported reduction in pain (percentage), pre- and postprocedure. The primary endpoint measurement was 2 weeks postinjection. Adverse effects were recorded. Results: The number of patients who received each dose varied: n = 88 received 120 mg, n = 30 received 80 mg, and n = 13 received 40 mg. The NPS pain scores pre- and postprocedure for 120 mg were 8.89 ± 1.32 and 4.08 ± 3.74, (mean ± standard deviation), respectively; for 80 mg: 9.06 ± 1.00 and 3.75 ± 4.00; and for 40 mg: 9.00 ± 1.00 and 4.00 ± 0.00. Percentage of pain relief for 120 mg, 80 mg, and 40 mg was 57.26%, 50.74%, and 57.26, respectively (P = 0.3347). n = 4 experienced adverse effects, all received 120 mg. Conclusions: All 3 dosage groups had similar efficacy in pain relief, but only patients who received 120 mg experienced adverse effects. This demonstrates that lower dosages can be used for pain relief with less potential harm to the patient. Key words: Methylprednisolone, interlaminar epidural, radiculopathy

scholarly journals Effect of High-Volume Injectate in Lumbar Transforaminal Epidural Steroid Injections: A Randomized, Active Control Trial

2015 ◽  
Vol 6;18 (6;11) ◽  
pp. E519-E525
Author(s):  
Hahck Soo Park
Keyword(s):  
Pain Relief ◽  
Active Control ◽  
High Volume ◽  
Radicular Pain ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Number Of Patients ◽  
Significant Difference ◽  
Low Volume ◽  
Epidural Steroid

Background: There have been many studies proving the effectiveness of lumbar transforaminal epidural steroid injections (TFESIs) for the treatment of radicular pain. Dexamethasone has been suggested as an alternative to particulate steroids. However, no controlled trials have investigated the effect of different injected volumes for a same dose of dexamethasone. Objective: To compare the effects of a high-volume injectate with those of a low-volume injectate using the same dose of dexamethasone for 2 groups in lumbar TFESI. Study Design: A prospective, randomized, active control trial. Setting: The outpatient clinic of a single academic medical center. Methods: A total of 66 patients were randomized to receive lumbar transforaminal epidural dexamethasone injections with either a low-volume injectate (3mL, N = 30) or a high-volume injectate (8mL, N = 32). The primary outcome measures for this study were the incidence of the patients achieving meaningful pain relief and a reduction on the Visual Analogue Scale (VAS, range 0 – 100) at 4 weeks after the procedure. The definition of “meaningful pain relief” was ≥ 50% from baseline. The secondary outcomes included the Roland-Morris Disability Questionnaire (RMDQ, range 0 – 24) score and adverse effects. The outcomes were assessed 4 weeks after the procedure. Results: Four weeks after the procedure, in the DL8 group, the incidence of achieving meaningful pain relief was higher compared with DL3 group (19, 59.4% vs. 9, 30%, P = 0.024). Both groups demonstrated a significant improvement in their VAS and RMDQ scores (P < 0.05). The VAS of the high-volume injectate group (DL8) was significantly lower than that of the low-volume injectate group (DL3) (33.3 ± 25 vs. 46.3 ± 25, P = 0.036). There was no significant difference in the RMDQ score between the 2 groups. Limitations: We enrolled a small number of patients and did not assess the long-term outcomes. Conclusions: Injectate at a volume of 8 mL was more effective than injectate at a volume of 3 mL for radicular pain in a lumbar transforaminal steroid injection, although both of the injectates contained the same dose of dexamethasone. Key words: Dexamethasone, disc herniation, epidural injection, lumbar, radiculopathy

scholarly journals Caudal Epidural Steroid Injection under Fluoroscopy in Management of Chronic Low Back Pain with or without Radiculopathy

2020 ◽  
Vol 9 (1) ◽  
pp. 3-7
Author(s):  
Rupak Bhattarai ◽  
Bandana Paudel ◽  
Sangeeta Subba ◽  
Kumud Pyakurel ◽  
Bijay K. C. ◽  
...  
Keyword(s):  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Pain Clinic ◽  
Low Back ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Vas Score ◽  
Epidural Steroid ◽  
Caudal Epidural

Background: Low back pain with or without radiculopathy is most common presentations of chronic pain. Caudal epidural steroid injection is one of the treatment modalities of this type of pain syndromes. Materials and Methods: The study was conducted in 100 patient who presented in our pain clinic. These patients were given caudal epidural steroid injections under fluoroscopy guidance with 60 mg depo-methylprednisolone added to 0.5% lignocaine making a volume of 10 ml. All these patients were asked to follow up at pain clinic at 1 month, 3 months & 6 months to assess the visual analogue scale (VAS) score, Oswestry disability index (ODI), Straight leg Raise test (SLRT) & Patient satisfaction scale. Results: There was significant reduction in VAS score in one month, three months and six months follow up after caudal epidural steroid injection. The 50% reduction in pain was seen in 72 patients, 69 patients and 62 patients in one month, three months and six months respectively. The mean VAS score were 7.84 before pre-injection, 4.32 at one hour, 4.06 at one month, 4.18 at 3 months and 4.64 at 6 months after the procedure.The mean ODI were 35.16 before pre-injection, 32.12 at one hour, 28.14 at one month, 28.57 at 3 months and 28.68 at 6 months after the procedure. Conclusion: Caudal epidural steroid injections causes significant relief in pain symptoms of backache with or without radiculopathy and increases the quality of life.  

The Value of Short-Term Pain Relief in Predicting the Long-Term Outcome of Lumbar Transforaminal Epidural Steroid Injections

2017 ◽  
Vol 107 ◽  
pp. 764-771 ◽  
Author(s):  
Holger Joswig ◽  
Armin Neff ◽  
Christina Ruppert ◽  
Gerhard Hildebrandt ◽  
Martin Nikolaus Stienen
Keyword(s):  
Pain Relief ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid

scholarly journals Immediate and Acute Adverse Effects Following Transforaminal Epidural Steroid Injections with Dexamethasone

2015 ◽  
Vol 3;18 (3;5) ◽  
pp. 277-286
Author(s):  
Omar Hammam El Abd, MD
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Spinal Pain ◽  
Radicular Pain ◽  
Steroid Injections ◽  
Epidural Injections ◽  
Epidural Steroid Injections ◽  
Phone Calls ◽  
Time Period ◽  
Epidural Steroid

Background: Transforaminal epidural steroid injections (TFESI) are widely used for the conservative treatment of radicular pain. The use of dexamethasone in TFESIs is relatively new; therefore, immediate and acute adverse effects that it may cause are not fully updated. Objective: To evaluate immediate and acute adverse effects following TFESI with dexamethasone. Study Design: Prospective, observational study. Setting: A spine center affiliated with a rehabilitation hospital. Methods: One hundred fifty consecutive patients receiving TFESI for the management of radicular and axial spinal pain at the cervical, lumbar, and sacral levels with dexamethasone using fluoroscopic guidance with digital subtraction technology were enrolled. The occurrence of adverse effects in patients in the 2-week time period following interventions was monitored through a set of questionnaires followed up by phone calls scheduled for 1 day, day 3, and day 14. Intensity and duration of side effects were recorded. Results: Of the 150 patients enrolled, 31 patients (19.5%) experienced adverse effects within the first 30 minutes following the intervention. The most common adverse effects were numbness and tingling in the limb, which developed in 19 patients (11.95%) followed by perineal pruritus that occurred in 7 cases (4.4%). Patients also reported experiencing adverse effects within the 3 days following intervention; most complained of headaches, insomnia, hiccups, flushing, and increased radicular pain. No major complications were noted. Limitations: The sample size enrolled might be too small to perceive possible rare side effects related to the procedure. The 2-week follow-up period is a limitation for evaluating late side effects. Conclusions: This study offers provision to interventionalists that TFESI with dexamethasone when performed by experienced hands and with proper technique has minor self-limited transient adverse effects that can be easily managed. Patients should be made aware of these adverse effects and their management. Further larger studies are needed to validate the safe use of dexamethasone and the safety of transforaminal epidural injections. Key words: Transforaminal epidural steroid injection, complications, dexamethasone

scholarly journals Caudal Epidural Steroid Injections in the Setting of Remaining on Antithrombotics: A Retrospective Study

2021 ◽  
Vol 24 (6) ◽  
pp. E821-E828
Keyword(s):  
Chart Review ◽  
Medical Condition ◽  
Retrospective Chart Review ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid ◽  
Antithrombotic Medication ◽  
Lost To Follow Up ◽  
Caudal Epidural

BACKGROUND: The American Society of Regional Anesthesia currently recommends ceasing antithrombotic medications for all spinal epidural steroid injections, however there is a paucity of data on the true risk of spinal epidurals via various approaches versus the risk of cessation of an agent as it relates to the underlying medical condition. OBJECTIVE: This study evaluated the complication rate of caudal epidural steroid injections in patients who remain on antithrombotic medications. STUDY DESIGN: Retrospective chart review. SETTING: Physiatric Spine Clinic in Orthopedic Specialty Office and Surgical Center. METHODS: A retrospective chart review was performed identifying patients (n = 335) who received a caudal epidural steroid injection (n = 673) from June 2015 through April 2020. Patients were included if they had received the injection while taking an antithrombotic medication. Patients were excluded if they were not taking an antithrombotic. The patient’s age, indication for the injection including magnetic resonance imaging or computed tomography findings, antithrombotic medication, the medical condition requiring an antithrombotic, and any complications following the injection were collected via chart review. RESULTS: Of the 443 injections included in the study, 51 encounters were lost to follow-up. Of the other 392 injections, there were no reported complications, regardless of the patient’s imaging findings, age, the antithrombotic medication used, or the underlying medical condition for which an antithrombotic medication was indicated. LIMITATIONS: This is a retrospective study. Therefore, a prospective study may have yielded fewer encounters lost to follow-up. Patients were not contacted directly after the procedure and chart reviews were utilized to evaluate for complications, which was limited to a patient’s reporting of perceived complications without any imaging. CONCLUSIONS: We conclude that caudal epidural steroid injections can be performed safely in patients while taking antithrombotic medications. Catastrophic events have been observed in patients who have discontinued antithrombotic agents preceding procedures. Thus, discontinuing antithrombotic medications may pose a greater risk than benefit for patients on an antithrombotic medication who have painful lumbar radiculopathy. KEY WORDS: Epidural injection, caudal, antithrombotic, safety, steroids, anticoagulant, antiplatelet, epidural hematoma

Sign in / Sign up

Export Citation Format

Share Document