EFFECTS OF CAUDAL EPIDURAL STEROID INJECTION FOR LOW BACK PAIN AND SCIATICA

Abstract

Objective: To evaluate the short term effects of high volume of injectate containing local anesthetics and steroids as compared to low volume injectate of the same drugs and the need for repetition as a means of treatment for patients suffering from severe chronic low backache (LBP) and sciatica.

Study Design: Quasi experimental study, interventional.

Place and Duration of Study: Department of Anaesthesia, Combined Military Hospital (CMH) Peshawar and CMH Gujranwala from Jun 2008 to Jun 2013.

Material and Methods: This quasi experimental double blind study was carried out in the department of Anaesthesia, CMH Peshawar and CMH Gujranwala from Jun 2008 to Jun 2013. A total of 100 patients were distributed into two equal groups A and B according to inclusion and exclusion criteria. All the patients were
clinically examined along with basic investigations. After confirming the epidural space 80 milligram (2ml) of methyl prednisolone mixed either with 0.25% bupivacaine, 0.2 ml/kg in group A or 0.125% bupivacaine, 0.4 ml/kg in group B was injected into the caudal epidural space.

Results: Clinical evaluation was performed at the time of enrolment (visit 1), after 2 weeks (visit 2), 6 weeks (visit 3), 3 months (visit 4) and 6 months (visit 5). On visit 5 i.e. 6 months after the start of the study the total patients in group A and B were 43 and 41 respectively. According to Denis Pain Scale 23 patients (53%) in group A and 26 patients (63%) in group B showed improvement (p value <0.05). According to MacNab’s criteria 33 patients (77%) in group A and 35 patients (85%) in groups B showed improvement (p value <0.05). Regarding weekly intake of medicines 12 patients (27.9%) in group A and 16 patients (39.0%) in group B, had 50% reduction in their weekly intake of pain killers (p value <0.05). In group B the number of patients showing improvement was 4 more than
group A which was statistically significant (p value 0.041). The incidence of hypotension after the injections was 4 (2.76%) in group A and 7 (5.03%) in group B (p value <0.05). None of the patients in group A but 4 patients (2.88%) in group B (p value <0.05) had difficulty in voiding urine after two hours. All the complications were self-limiting and settled without any morbidity or need for hospitalization.

Conclusions: Caudal epidural steroid injections 0.2 ml/kg as well as 0.4 ml/kg show significant improvement in patients with low backache un-responsive to conservative measures alone. High volume injectate is more effective as compared to low volume but there is significantly increased risk of complications like hypotension and difficulty in voiding urine.