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Single Shot Epidural Injection for Cervical and Lumbosaccral Radiculopathies: A Preliminary Study

  • Received : 2010.05.31
  • Accepted : 2010.10.27
  • Published : 2010.12.01

Abstract

Background: Epidural steroid injection is an established treatment modality for intervertebral disc prolapse to radiculopathy. In cases where two levels of radiculopathy are present, two separate injections are warranted. Herein, we present our experience of management of such cases with a single epidural injection of local anaesthetic, tramadol and methylprednisolone, and table tilt for management of both radiculopathies. Methods: 50 patients of either sex aged between 35-65 years presenting with features of cervical and lumbar radiculopathic pain were included and were subjected to single lumbar epidural injection of local anaesthetic, tramadol and methylprednisolone, in the lateral position. The table was then tilted in the trendelberg position with a tilt of 25 degrees, and patients were maintained for 10 minuted before being turned supine. All patients were administered 3 such injections with an interval of 2 weeks between subsequent injections, and pain relief was assessed with a visual analogue scale. Immediate complications after the block were assessed. Results: Immediate and post procedural complications observed were nausea and vomiting (20%), painful injection site (4%), hypotension (10%) and high block (4%). Pain relief was assessed after the three injections by three grades: 37 (74%) had complete resolution of symptoms; 18% had partial relief and 8% did not benefit from the procedure. Conclusions: This technique may be used as an alternative technique for pain relief in patients with unilateral cervical and lumbar radiculopathies.

Keywords

References

  1. Cote P, Cassidy JD, Carroll L. The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain and related disability in Saskatchewan adults. Spine 1998; 23: 1689-98. https://doi.org/10.1097/00007632-199808010-00015
  2. Bovim G, Schrader H, Sand T. Neck pain in the general population. Spine 1994; 19: 1307-9. https://doi.org/10.1097/00007632-199406000-00001
  3. Linton SJ, Hallden K. Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain. Clin J Pain 1998; 14: 209-15. https://doi.org/10.1097/00002508-199809000-00007
  4. Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain 1994; 117: 325-35. https://doi.org/10.1093/brain/117.2.325
  5. Goebert HW Jr, Jallo SJ, Gardner WJ, Wasmuth CE. Painful radiculopathy treated with epidural injections of procaine and hydrocortisone acetate: results in 113 patients. Anesth Analg 1961; 40: 130-4.
  6. Berman AT, Garbarino JL Jr, Fisher SM, Bosacco SJ. The effects of epidural injection of local anesthetics and corticosteroids on patients with lumbosciatic pain. Clin Orthop Relat Res 1984; 188: 144-51.
  7. Catchlove RF, Braha R. The use of cervical epidural nerve blocks in the management of chronic head and neck pain. Can Anaesth Soc J 1984; 31: 188-91. https://doi.org/10.1007/BF03015258
  8. Pawl RP, Anderson W, Shulman M. Effect of epidural steroids in the cervical and lumbar region on surgical intervention for diskogenic spondylosis. In: Proceedings of the Fourth World Congress on Pain (Advances in Pain Research and Therapy). 9th ed. Edited by Cervero F. New York, Raven Press. 1985, pp 791-8.
  9. Shulman M, Nimmagadda U, Valenta A. Cervical epidural steroid injection for pain of cervical spine origin. Anesthesiology 1984; 61: A223. https://doi.org/10.1097/00000542-198409001-00223
  10. Malhotra G, Abbasi A, Rhee M. Complications of transforaminal cervical epidural steroid injections. Spine 2009; 34: 731-9. https://doi.org/10.1097/BRS.0b013e318194e247
  11. Raj PP. Intervertebral disc: anatomy-physiology-pathophysiology-treatment. Pain Pract 2008; 8: 18-44. https://doi.org/10.1111/j.1533-2500.2007.00171.x
  12. Koes BW, Scholten RJ, Mens JM, Bouter LM. Efficacy of epidural steroid injections for low-back pain and sciatica: a systematic review of randomized clinical trials. Pain 1995; 63: 279-88. https://doi.org/10.1016/0304-3959(95)00124-7
  13. Koes BW, Scholten RJ, Mens JM, Bouter LM. Efficacy of spinal steroid injection for low back ache and sciatica: an updated systemic review of randomized control trial. Pain Digest 1999; 9: 241-7.
  14. Bogduk N, McGuirk B. Monotherapy. In: Medical management of acute and chronic low back pain. 13th ed. Netherlands, Elsevier Science. 2002, pp 143-62.
  15. Abdi S, Datta S, Lucas LF. Role of epidural steroids in the management of chronic spinal pain: a systematic review of effectiveness and complications. Pain Physician 2005; 8: 127-43.
  16. Abdi S, Datta S, Trescot AM, Schultz DM, Adlaka R, Atluri SL, et al. Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician 2007; 10: 185-212.
  17. Driessen B, Reimann W. Interaction of the central analgesic, tramadol, with the uptake and release of 5-hydroxytryptamine in the rat brain in vitro. Br J Pharmacol 1992; 105: 147-51. https://doi.org/10.1111/j.1476-5381.1992.tb14226.x
  18. Raffa RB, Friderichs E, Reimann W, Shank RP, Codd EE, Vaught JL. Opioid and non-opioid components independently contribute to the mechanism of action of tramadol, an 'atypical' opioid analgesic. J Pharmacol Exp Ther 1992; 260: 275-85.
  19. Tsai YC, Chang PJ, Jou IM. Direct tramadol application on sciatic nerve inhibits spinal somatosensory evoked potentials in rats. Anesth Analg 2001; 92: 1547-51.
  20. Pang WW, Huang PY, Chang DP, Huang MH. The peripheral analgesic effect of tramadol in reducing propofol injection pain: a comparison with lidocaine. Reg Anesth Pain Med 1999; 24: 246-9.
  21. Derby R, Lee SH, Kim BJ, Chen Y, Seo KS. Complications following cervical epidural steroid injections by expert interventionalists in 2003. Pain Physician 2004; 7: 445-9.
  22. Botwin KP, Castellanos R, Rao S, Hanna AF, Torres-Ramos FM, Gruber RD, et al. Complications of fluoroscopically guided interlaminar cervical epidural injections. Arch Phys Med Rehabil 2003; 84: 627-33. https://doi.org/10.1016/S0003-9993(02)04862-1
  23. Scanlon GC, Moeller-Bertram T, Romanowsky SM, Wallace MS. Cervical transforaminal epidural steroid injections: more dangerous than we think? Spine 2007; 32: 1249-56. https://doi.org/10.1097/BRS.0b013e318053ec50
  24. Apostolou GA, Zarmakoupis PK, Mastrokostopoulos GT. Spread of epidural anesthesia and the lateral position. Anesth Analg 1981; 60: 584-6.
  25. Makki D, Nawabi DH, Francis R, Hamed AR, Hussein AA. Is the outcome of caudal epidural injections affected by patient positioning? Spine 2010; 35: E687-90. https://doi.org/10.1097/BRS.0b013e3181d41545
  26. Setayesh AR, Kholdebarin AR, Moghadam MS, Setayesh HR. The trendelenburg position increases the spread and accelerates the onset of epidural anesthesia for cesarean section. Can J Anaesth 2001; 48: 890-3. https://doi.org/10.1007/BF03017356
  27. Coppejans HC, Hendrickx E, Goossens J, Vercauteren MP. The sitting versus right lateral position during combined spinal-epidural anesthesia for cesarean delivery: block characteristics and severity of hypotension. Anesth Analg 2006; 102: 243-7. https://doi.org/10.1213/01.ane.0000189049.11005.26

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