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RT Journal Article
SR Electronic
T1 Immediate Pain Response to Interlaminar Lumbar Epidural Steroid Administration: Response Characteristics and Effects of Anesthetic Concentration
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 239
OP 246
DO 10.3174/ajnr.A3170
VO 34
IS 1
A1 Bartynski, W.S.
A1 Jennings, R.B.
A1 Rothfus, W.E.
A1 Agarwal, V.
YR 2013
UL http://www.ajnr.org/content/34/1/239.abstract
AB BACKGROUND AND PURPOSE: Interlaminar LESIs are commonly used to treat LBP or radiculopathy. Most studies focus on the long-term outcomes of LESI. The purpose of this study is to evaluate the immediate effects of fluoroscopically guided LESI on LBP/radiculopathy including low- or high-strength anesthetic response. MATERIALS AND METHODS: The procedure notes, post-procedure records, and imaging records dedicated spine nurse assessments, and imaging records were retrospectively evaluated in 392 fluoroscopically guided LESIs performed in 276 patients (nonrandomized, nonblinded; 131 males, 145 females; average age, 56 years) with LBP/radiculopathy using either low- or high-strength anesthetic (80 mg of methylprednisilone mixed with bupivacaine [0.25% or 0.5%]). Post-procedure documentation of the patient's pre- and postprocedure VAS pain-scale level were tabulated. RESULTS: Single LESI was performed in 199 patients, with multiple LESIs in 77 (193 injections). Low-strength bupivacaine (0.25%) was used in 237 injections, with high-strength (0.5%) in 155. Complete to near-complete immediate pain relief (&lt;20% residual pain) was reported after 197 of 392 (50.3%) injections. No pain relief was reported after 60 (15.4%) injections (&gt;80% residual), with partial relief in the remainder. No statistical difference was noted between low- and high-anesthetic strength or between single- and multiple-injection patients. In multiple-LESI patients, consistent pain relief response was noted in 39 of 77 (50.6%) patients, with improving LESI response in 20.8%, deteriorating LESI response in 19.5%, and variable response in 9.1%. CONCLUSIONS: An immediate pain-extinction response is identified after LESI, which appears independent of anesthetic strength. This observation may relate to pain origin and/or pain nociceptor afferent pathway in an individual patient and potentially relate to treatment response. APanteroposteriorDRGdorsal root ganglionLBPlow back painLESIlumbar epidural steroid injectionVASVisual Analog Scale