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Anesth Analg 2002 Apr;94(4):1010-3, table of contents
Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York 10021, USA.
IMPLICATIONS: We report a case of possible bupivacaine toxicity after intraarticular injection during knee arthroscopy. The importance of the specific type of surgical procedure performed during arthroscopy and its relationship to potential local anesthetic toxicity are highlighted.
PMID: 11916814, UI: 21914019
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Anesth Analg 2002 Apr;94(4):996-1000, table of contents
Department of Anesthesiology, CTO Roma, Italy.
To compare the posterior popliteal and subgluteal continuous sciatic nerve block for anesthesia and acute postoperative pain management after foot surgery, 60 ASA physical status I and II patients undergoing elective orthopedic foot surgery were randomly assigned to either a Subgluteal group (n = 30) or Popliteal group (n = 30). Before surgery and after performing a femoral nerve block with 15 mL of 2% mepivacaine, we performed the sciatic nerve block with 20 mL of 0.75% ropivacaine using either a subgluteal or posterior popliteal approach, and the placement of a catheter came afterward. In the recovery room, the catheter was connected to a patient-controlled analgesia pump to infuse 0.2% ropivacaine (basal infusion rate of 5 mL/h, incremental bolus of 10 mL, and a lockout time of 60 min). There were no technical problems in catheter placement. Intraoperative efficacy of nerve block was similar in the two groups. Postoperative catheter displacement and occlusion were recorded in four patients in the Popliteal group and two patients in the Subgluteal group (P = 0.67). Both approaches provided similar postoperative analgesia. We conclude that the subgluteal approach is as effective and safe as the previously described posterior popliteal approach for continuous sciatic block and can be considered a useful alternative to anesthesia and acute postoperative analgesia after foot procedures. IMPLICATIONS: Comparing two different approaches for continuous sciatic nerve block after orthopedic foot surgery, this prospective, randomized study demonstrated that the subgluteal approach is as effective and safe as the previously described posterior popliteal approach, and can be considered a useful alternative to anesthesia and acute postoperative analgesia after foot procedures.
PMID: 11916811, UI: 21914016
Anesth Analg 2002 Apr;94(4):987-90, table of contents
Department of Anesthesiology, Vita-Salute University, IRCCS H. San Raffaele, Milan, Italy. casati.andrea@hsr.it
To compare intraoperative and postoperative clinical properties of levobupivacaine and ropivacaine for sciatic nerve block, 50 ASA physical status I and II patients undergoing hallux valgus repair received a femoral nerve block with 15 mL of 2% mepivacaine. They were then randomly allocated in a double-blinded fashion to receive a sciatic nerve block with either 0.5% levobupivacaine (n = 25) or 0.5% ropivacaine (n = 25). An independent blinded observer evaluated the onset time of surgical anesthesia as well as the quality of the surgical block and postoperative analgesia. The median (range) onset time of surgical block at the sciatic nerve distribution was 30 min (5-60 min) with levobupivacaine and 15 min (5-60 min) with ropivacaine (P = 0.63). Four patients (two patients in each group) received a supplementary ankle block by the surgeon just before the beginning of surgery. All four patients also received IV fentanyl supplementation, but in three of them, propofol infusion was required to complete surgery (two in the Levobupivacaine group [8%] and one in the Ropivacaine group [4%]; P = 0.99). In six patients of the Levobupivacaine group (24%) and five patients of the Ropivacaine group (20%), IV fentanyl supplementation was required to complete surgery (P = 0.99). No differences in the time to recovery of sensory and motor function were observed between the two groups, whereas median (range) duration of postoperative analgesia was 16 h (8-24 h) with levobupivacaine and 16 h (8-24 h) with ropivacaine (P = 0.83). We conclude that 0.5% levobupivacaine and 0.5% ropivacaine provide comparable surgical anesthesia and postoperative analgesia. IMPLICATIONS: No studies have compared the clinical properties of levobupivacaine with those of ropivacaine when providing sciatic nerve block for hallux valgus repair. Results from this prospective, randomized, double-blinded study demonstrate that 20 mL of either 0.5% levobupivacaine or 0.5% ropivacaine provide comparable surgical block with prolonged postoperative analgesia.
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PMID: 11916809, UI: 21914014
Anesth Analg 2002 Apr;94(4):975-80, table of contents
Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada.
We examined the effects of systemically administered gabapentin on flinching and biting/licking behaviors produced by 2.5% formalin in the rat, compared these with those of amitriptyline, and determined the effects of combinations of gabapentin with amitriptyline. Gabapentin produced a dose-related inhibition of Phase 2, but not Phase 1, flinching and biting/licking behaviors. In contrast, amitriptyline produced an increase in Phase 2 flinching behaviors while simultaneously decreasing biting/licking behaviors. Fifty percent effective dose (ED50) values against biting/licking behaviors were 22.9 +/- 1.3 mg/kg and 8.5 +/- 1.3 mg/kg for gabapentin and amitriptyline, respectively. Combinations of increasing fractional increments of ED50 doses of gabapentin and amitriptyline produced an additive effect against biting/licking behaviors, as revealed by isobolographic analysis. These increments had no effect on flinching behaviors except at the ED25 + ED25 doses, at which flinching was increased, again revealing additivity between the two drugs. Flinching behaviors in rats do not reflect the analgesic properties of systemically administered amitriptyline observed in humans and may not be useful for predicting an effect of combinations of drugs with amitriptyline. Biting/licking behaviors do reflect analgesic properties for both drugs and may be more useful in this regard. IMPLICATIONS: By use of the rat formalin test, a model of persistent pain, we examined the effect of a combination of amitriptyline and gabapentin, which are used to treat chronic pain in humans. The drug combination produced additive analgesia against one outcome, but another outcome was more ambiguous.
PMID: 11916807, UI: 21914012
Anesth Analg 2002 Apr;94(4):867-71, table of contents
Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, School of Medicine, Philadelphia 19104, USA. rose@email.chop.edu
In this randomized, double-blinded, placebo-controlled study, we evaluated the safety and efficacy of lidocaine iontophoresis for the prevention of pain associated with venipuncture in 59 children aged 6-17 yr. Children received either lidocaine HCl 2% with epinephrine 1:100,000 (Active) or the same formulation without lidocaine (Placebo) via a 20 mA/min iontophoretic treatment. Pain during venipuncture was assessed by the subject, parent, and nurse using a 100-mm visual analog scale. Median (interquartile range) visual analog scale scores were significantly lower in the Active versus Placebo groups: subject, 7.0 (2.0-20.8) versus 31.0 (12.0-48.0), P < 0.001; nurse, 5.0 (2.2-10.8) versus 24.0 (9.0-47.0), P < 0.001; and parent, 3.0 (0.8-7.2) versus 20.0 (4.5-43.0), P < 0.002, respectively. Similarly, higher median satisfaction scores were given to the Active versus Placebo group by the three evaluators. Of the 59 subjects completing the study, 10 subjects experienced a total of 12 adverse events that were all graded as mild. In conclusion, lidocaine iontophoresis is safe in children, reduces discomfort associated with venipuncture, and increases satisfaction when compared with the placebo. IMPLICATIONS: In this randomized, double-blinded, placebo-controlled study, we found that dermal anesthesia with lidocaine HCl 2% combined with epinephrine 1:100,000 administered via iontophoresis in children is achieved in 8.8 +/- 2.1 min, reduces discomfort associated with venipuncture, is safe, and increases satisfaction when compared with the placebo.
PMID: 11916787, UI: 21913992
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Anesthesiology 2002 Mar;96(3):762-4
Department of Anesthesiology, Orthopedic University Clinic Zurich/Balgrist, Zurich, Switzerland.
PMID: 11873056, UI: 21861200
Anesthesiology 2002 Mar;96(3):633-40
Department of Pharmacology, University College London, London, United Kingdom. e,matthews@ucl.ac.uk
BACKGROUND: Peripheral nerve damage can result in severe, long-lasting pain accompanied by sensory deficits. This neuropathic pain remains a clinical problem, and effective morphine analgesia is often limited by intolerable side effects. The antiepileptic gabapentin has recently emerged as an alternative chronic pain treatment. Improved management of the diverse symptoms and mechanisms of neuropathic pain may arise from combination therapy, based on multiple pharmacologic targets and low drug doses. METHODS: The authors used the Kim and Chung rodent model of neuropathy to induce mechanical and cold allodynia in the ipsilateral hind paw. In vivo electrophysiologic techniques were subsequently used to record evoked dorsal horn neuronal responses in which the effects of systemic morphine and gabapentin were investigated, both individually and in combination. RESULTS: Morphine (1 and 4 mg/kg) inhibited neuronal responses of control rats but not after neuropathy. Gabapentin (10 and 20 mg/kg) inhibited neuronal responses in nerve injured rats and to a lesser extent in sham rats but not in naive rats. In the presence of gabapentin (ineffective low dose of 10 mg/kg), morphine (1 and 3 mg/kg) mediated significant inhibitory effects in all experimental groups, with the greatest inhibitions observed in spinal nerve-ligated and sham-operated rats. After neuropathy, inhibitions mediated by morphine were significantly increased in the presence of gabapentin compared with morphine alone. CONCLUSIONS: After spinal nerve ligation, the inhibitory effects of systemic morphine on evoked dorsal horn neuronal responses are reduced compared with control, whereas the effectiveness of systemic gabapentin is enhanced. In combination with low-dose gabapentin, significant improvement in the effectiveness of morphine is observed, which demonstrates a clinical potential for the use of morphine and gabapentin combinational treatment for neuropathic pain.
PMID: 11873039, UI: 21861183
Anesthesiology 2002 Mar;96(3):526-7
PMID: 11873022, UI: 21861166
Ann Intern Med 2002 Apr 16;136(8):630
Boston University Arthritis Center; Boston, MA 02118.
[Medline record in process]
PMID: 11955033, UI: 21952285
University of Washington; Seattle, WA 98195-6428.
PMID: 11955032, UI: 21952284
BMJ 2002 Apr 13;324(7342):915
PMID: 11951910, UI: 21948396
PMID: 11951909, UI: 21948395
Br J Anaesth 2002 Feb;88(2):303-4; discussion 303-4
PMID: 11883391, UI: 21867456
Br J Anaesth 2001 Dec;87(6):866-9
Hospital Clinico Universidad Catolica de Chile, Departamento de Anestesiologia, Santiago.
We have prospectively assessed whether remifentanil-based anaesthesia is associated with clinically relevant acute opioid tolerance, expressed as greater postoperative pain scores or morphine consumption. Sixty patients undergoing elective gynaecological, non-laparoscopic, surgery were randomly assigned to receive remifentanil (group R, n=30) or sevoflurane (group S, n=30) based anaesthesia. Postoperative analgesia was provided with morphine through a patient-controlled infusion device. Mean (SD) remifentanil infusion rate in group R was 0.23 (0.10) microg kg(-1) min(-1) and mean inspired fraction of sevoflurane in group S was 1.75 (0.70)%. Mean (SD) cumulative morphine consumption during the first 24 postoperative hours was similar between groups: 28.0 (14.2) mg (group R) vs 28.6 (12.4) mg (group S). Pain scores, were also similar between groups during this period. These data do not support the development of acute opioid tolerance after remifentanil-based anaesthesia in this type of surgery.
PMID: 11878688, UI: 21867476
Br J Anaesth 2002 Feb;88(2):215-26
Department of Pharmaceutics, The Royal Danish School of Pharmacy, Copenhagen.
BACKGROUND: We have reviewed the analgesic efficacies of rectal and parenteral paracetamol and tested the evidence for a possible additive analgesic effect of the combination of paracetamol with a non-steroidal anti-inflammatory drug (NSAID) in postoperative pain. METHODS: Randomized controlled trials were evaluated. Outcome measures were pain scores and demand for supplementary analgesia. RESULTS: Eight studies compared rectal paracetamol with placebo. One study of single-dose administration of rectal paracetamol 40-60 mg kg(-1) and three studies of repeat dosing with 14-20 mg kg(-1) showed significant analgesic efficacy, while studies of a single dose of 10-20 mg kg(-1) were negative. Ten studies compared parenteral paracetamol with placebo and eight studies showed improved pain relief with paracetamol. Of the nine studies comparing paracetamol with a combination of paracetamol and an NSAID, six studies showed improved pain relief for the combination while only two of the six studies comparing an NSAID with a combination of an NSAID and paracetamol showed improved pain relief for the combination. CONCLUSIONS: Considering the few studies available, evidence was found of a clinically relevant analgesic effect of rectal and parenteral paracetamol. Concurrent use of paracetamol and an NSAID was superior to paracetamol alone but no evidence was found of superior analgesic effect of the combination compared with the NSAID alone.
PMID: 11878655, UI: 21867437
Clin Orthop 2002 Apr;(397):434-41
Division of Pediatric Orthopaedics and the Department of Pathology, Valley Children's Hospital, Madera, CA; and the Department of Surgery, UCSF, San Francisco, CA.
PMID: 11953638, UI: 21950199
J Clin Oncol 2002 Mar 15;20(6):1707-8
PMID: 11896124, UI: 21893341
J Pediatr 2002 Mar;140(3):315-20
Departments of Pediatrics, Uddevalla and NAL Hospital, Queen Silvia's Hospital for Children and Adolescents, Gothenburg, Sweden.
OBJECTIVES: To investigate the use of indwelling catheters as injection aids at diabetes onset to reduce injection pain and pre-injection anxiety.Study design: Forty-one patients aged 8.1 +/- 3.7 years (range, 1-15) participated in this open, controlled randomized study. A 10-cm VAS with faces was used for scoring. A local anesthetic cream was used before all insertions. The control group used insulin pens with standard needles. After one week, the indwelling catheter group could choose regular injections but were included in the "intention to treat" analysis. RESULTS: Injection pain and anxiety decreased from day 1 to 15 in both groups (average, 4.1 injections/day). Pain was significantly lower for indwelling catheter injections when scored by parents (median, 1.2 cm vs 2.7 cm; P =.002), children/teenagers (0.8 cm vs 1.5 cm; P =.006), and nurses (1.4 cm vs 3.0 cm; P =.002). Parental pre-injection anxiety was also lower (1.2 cm vs 2.9 cm; P =.016). Taking injections, including inserting catheters, was found to be less problematic with an indwelling catheter (1.6 cm vs 3.3 cm;P =.009). During the 6-month follow-up, injection pain and injection problems were significantly lower in the catheter group. Mean catheter indwelling time was 3.7 days. Median pain for catheter insertion was 2.1 cm and for glucose testing was 0.9 cm. Sixteen of 20 patients continued to use indwelling catheters after 2 weeks, and 9 of 20 after 6 months. CONCLUSIONS: We found an evident relief of pre-injection anxiety and injection pain when using indwelling catheters for introducing insulin injections at the onset of diabetes.
PMID: 11953729, UI: 21950903
JAMA 2002 Apr 3;287(13):1638-9
PMID: 11926875, UI: 21925086
Lancet 2002 Apr 6;359(9313):1206
Institute of Anesthesiology-Intensive Care, University of Brescia, 25125, Brescia, Italy
PMID: 11955540, UI: 21953598
Reg Anesth Pain Med 2002 Mar-Apr;27(2):225; discussion 225-6
PMID: 11915075, UI: 21912604
Reg Anesth Pain Med 2002 Mar-Apr;27(2):168-72
Department of Anesthesiology, CTO Roma, Rome, Italy.
BACKGROUND AND OBJECTIVE: To compare continuous infusion or a patient-controlled technique for postoperative analgesia after foot surgery, using a new subgluteus approach for continuous sciatic nerve block. METHODS: Fifty healthy patients, undergoing orthopedic foot surgery, received a continuous sciatic nerve block using a new subgluteus approach. All blocks were placed with the aid of a nerve stimulator using a 10-cm, 18-gauge insulated Tuohy needle. After either plantar flexion or dorsiflexion of the operated foot was elicited at < or = 0.5 mA, 20 mL of 0.75% ropivacaine was injected incrementally using repeated aspiration tests, then followed by the introduction of a 20-gauge epidural catheter. Postoperatively, 0.2% ropivacaine was infused with either a 10 mL/h continuous infusion (group Continuous, n = 25) or with a 5 mL/h basal rate with 5 mL bolus every 60 minutes (group patient-controlled analgesia [PCA], n = 25). Intraoperative analgesic supplementation, as well as postoperative pain relief, morphine consumption, incidence of complication, and patient satisfaction were recorded by an observer unaware of group assignment. RESULTS: The sciatic catheter was successfully placed in all patients. Intravenous fentanyl supplementation (dose range, 50 to 150 microg) was required in 4 patients in each group, but no patient required general anesthesia. Catheter dislocation was reported in 2 patients (4%). The quality of pain relief was good in both groups, and none experienced complications. Nine patients of the Continuous group (37%) and 7 patients of the PCA group (29%) required rescue morphine analgesia because of pain in the femoral dermatomes (P =.76). Ropivacaine consumption was 240 mL in the Continuous group (range, 200 to 240 mL) and 140 mL in the PCA group (range, 120 to 290 mL) (P =.0005). Patient acceptance was good in both groups. CONCLUSIONS: The continuous subgluteus sciatic nerve block represents an easy and reliable option for postoperative analgesia after foot surgery; using a patient controlled rather than a continuous infusion technique reduces the consumption of local anesthetic solution without affecting the quality of pain relief.
PMID: 11915064, UI: 21912593
Reg Anesth Pain Med 2002 Mar-Apr;27(2):162-7
Department of Anesthesiology and Pain Management, Cook County Hospital, Chicago, IL 60611, USA. kcandido@msn.com
BACKGROUND AND OBJECTIVES: Buprenorphine added to local anesthetic solutions for supraclavicular block was found to triple postoperative analgesia duration in a previous study when compared with local anesthetic block alone. That study, however, did not control for potentially confounding factors, such as the possibility that buprenorphine was affecting analgesia through intramuscular absorption or via a spinal mechanism. To specifically delineate the role of buprenorphine in peripherally mediated opioid analgesia, the present study controlled for these 2 factors. METHODS: Sixty American Society of Anesthesiologists (ASA) P.S. I and II, consenting adults for upper extremity surgery, were prospectively assigned randomly in double-blind fashion to 1 of 3 groups. Group I received local anesthetic (1% mepivacaine, 0.2% tetracaine, epinephrine 1:200,000), 40 mL, plus buprenorphine, 0.3 mg, for axillary block, and intramuscular (IM) saline. Group II received local anesthetic-only axillary block, and IM buprenorphine 0.3 mg. Group III received local anesthetic-only axillary block and IM saline. Postoperative pain onset and intensity were compared, as was analgesic medication use. RESULTS: The mean duration of postoperative analgesia was 22.3 hours in Group I; 12.5 hours in group II, and 6.6 hours in group III. Differences between groups I and II were statistically significant (P =.0012). Differences both between groups I and III and II and III were also statistically significant (P <.001). CONCLUSIONS: Buprenorphine-local anesthetic axillary perivascular brachial plexus block provided postoperative analgesia lasting 3 times longer than local anesthetic block alone and twice as long as buprenorphine given by IM injection plus local anesthetic-only block. This supports the concept of peripherally mediated opioid analgesia by buprenorphine.
PMID: 11915063, UI: 21912592
Reg Anesth Pain Med 2002 Mar-Apr;27(2):157-61
Department of Anesthesiology, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126 Turin, Italy. gioivani@libero.it
BACKGROUND AND OBJECTIVES: To compare ropivacaine, levo-bupivacaine, and racemic bupivacaine for caudal blockade in children. METHODS: Using a prospective observer blinded design, 60 sevoflurane anesthetized children (1 to 7 years) undergoing minor subumbilical surgery, were randomized to receive a caudal block (1 mL/kg) with either ropivacaine 0.2%, racemic bupivacaine 0.25%, or levo-bupivacaine 0.25%. Postoperative analgesia (number of patients needing supplemental analgesia as defined by an objective pain score [OPS] score of > or = 5; time to first analgesic demand) during the first 24 postoperative hours was chosen as the primary end-point. Early postoperative motor block (3-point scale) was assessed as a secondary end-point. RESULTS: All blocks were judged to be clinically successful based on the presence of adequate intraoperative and early postoperative analgesia. An OPS score > or = 5 was found in 5/20 patients in each study group. No difference regarding the time to first analgesic demand was found between the study groups. The use of ropivacaine (P =.02), but not levo-bupivacaine (P =.18), was found to be associated with less motor block during the first postoperative hour compared with racemic bupivacaine. CONCLUSION: All 3 investigated local anesthetics were found to be clinically comparable despite the slight reduction of early postoperative motor block associated with the use of ropivacaine.
PMID: 11915062, UI: 21912591
Reg Anesth Pain Med 2002 Mar-Apr;27(2):145-9
Department of Orthopaedic Surgery, Dankook University College of Medicine, 16-5 Anseo-dong, Chonan City, Choongnam Prov., 330-715, Republic of Korea. drpark@chollian.net
BACKGROUND AND OBJECTIVES: The aim of this study was to determine whether an intrabursal morphine and bupivacaine mixed infusion provides useful analgesia for prolonged pain relief after subacromial arthroscopic operation. METHODS: A continuous intrabursal infusion catheter was inserted at the conclusion of the subacromial arthroscopic operation that was performed under general anesthesia. In a prospective, double-blind, randomized trial, 60 patients were divided into 2 groups: an anesthetic group received 5 mL of mixed 0.5% bupivacaine, 2 mg of morphine, 0.05 mL of 1/1,000 epinephrine as a bolus, and a solution of 40 mL of a 0.5% bupivacaine and 8 mg of morphine mixture that was used as a maintenance dose at a constant rate of 0.5 mL/h. This was done by means of a continuous infusion pump (0.5 mL hourly). A saline group (n = 30) received continuous saline infusion. Two patients were eliminated from the study because of catheter leakage or malfunction in the saline group. The intensity of the pain was evaluated preoperatively and postoperatively for 3 days by a graded visual analog scale (score from 0 to 10) for night pain, pain on motion, sleep disturbance, lying on painful shoulder, and the amounts of supplemental analgesics. RESULTS: Pain was decreased on the first and second postoperative day, and there was less sleep disturbance for 3 days postoperatively in the anesthetic group. There was no difference in pain caused by movement postoperatively. In the anesthetic group, lesser amounts of analgesics were used in the first 48 hours postoperatively. CONCLUSIONS: The continuous intrabursal infusion method resulted in a decreased perception of rest pain and reduced supplemental analgesics requirement for 2 days postoperatively.
PMID: 11915060, UI: 21912589
Reg Anesth Pain Med 2002 Mar-Apr;27(2):139-44
Department of Anesthesiology, Henry Ford Hospital, 2799 W. Grand Boulevard, Detroit, MI 48202, USA. hwang2@hfhs.org
BACKGROUND AND OBJECTIVES: Continuous-infusion femoral nerve block (FNB) improves analgesia and rehabilitation after total knee replacement. In this study, we investigated the efficacy of single-injection FNB to achieve similar results. METHODS: A total of 30 patients were prospectively and randomly assigned to receive 40-mL injections of either 0.25% bupivacaine (group B) or saline (group S) after total knee replacement. Blinded observers evaluated the patients for postoperative pain, morphine consumption, ambulating distances, and maximal knee flexion; pain was scored on the visual analog scale (VAS). RESULTS: Compared with group S patients, group B patients had significantly lower VAS pain scores (P <.01 in the postoperative anesthesia care unit, P <.05 on the day after surgery); group B patients also showed significantly lower total morphine use (P <.05) and a lower incidence of morphine-related side effects. Significantly more group B than group S patients could ambulate on the day after surgery (93% v 46%, P <.05), and mean ambulatory distance was significantly better for group B than group S patients at discharge (166 +/- 37 v 117 +/- 24 feet, P <.01). Knee flexion was significantly better for group B than group S patients on the second day after surgery (70 degrees v 60 degrees, P <.01), but the between-group difference was no longer statistically significant at discharge. Mean length of acute hospitalization was significantly shorter for group B (3 days; range, 3 to 5 days) than group S patients (4 days; range, 3 to 6 days, P <.05). CONCLUSIONS: Single-injection FNB provided effective analgesia, facilitated early ambulation, and reduced the length of acute hospitalization in patients undergoing total knee replacement.
PMID: 11915059, UI: 21912588
Spine 2002 Jan 1;27(1):11-6
The Hospital for Special Surgery, New York, New York 10021, USA. vadv@hss.edu
STUDY DESIGN: A prospective study randomized by patient choice from the private practice of a single physician affiliated with a major teaching hospital was conducted. OBJECTIVES: To compare transforaminal epidural steroid injections with saline trigger-point injections used in the treatment of lumbosacral radiculopathy secondary to a herniated nucleus pulposus. SUMMARY OF BACKGROUND DATA: Epidural steroid injections have been used for more than half a century in the management of lumbosacral radicular pain. At this writing, however, there have been no controlled prospective trials of transforaminal epidural steroid injections in the treatment of lumbar radiculopathy secondary to a herniated nucleus pulposus. METHODS: Randomized by patient choice, patients received either a transforaminal epidural steroid injection or a saline trigger-point injection. Treatment outcome was measured using a patient satisfaction scale with choice options of 0 (poor), 1 (fair), 2 (good), 3 (very good), and 4 (excellent); a Roland-Morris low back pain questionnaire that showed improvement by an increase in score; a measurement of finger-to-floor distance with the patient in fully tolerated hip flexion; and a visual numeric pain scale ranging from 0 to 10. A successful outcome required a patient satisfaction score of 2 (good) or 3 (very good), improvement on the Roland-Morris score of 5 or more, and pain reduction greater than 50% at least 1 year after treatment. The final analysis included 48 patients with an average follow-up period of 16 months (range, 12-21 months). RESULTS: After an average follow-up period of 1.4 years, the group receiving transforaminal epidural steroid injections had a success rate of 84%, as compared with 48% for the group receiving trigger-point injections (P < 0.005). CONCLUSION: Fluoroscopically guided transforaminal injections serve as an important tool in the nonsurgical management of lumbosacral radiculopathy secondary to a herniated nucleus pulposus.
PMID: 11805628, UI: 21664503
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