CAUDAL EPIDURAL STEROID INJECTIONS WITH BUPIVICAINE VERSUS WITH SALINE. A RANDOMIZED CONTROLLED CLINICAL TRIAL.

Abstract

Aim: To determine the need for caudal epidural steroid injections to be administered with a mixture containing local anaesthetic.

Patients: 100 consecutive patients listed for caudal epidural by two spinal orthopaedic consultants with lum-bosacral radiculopathic pain. 19 patients did not fulfil the criteria for the trial.

Methods: Subjects randomised to either steroid injection (80mg triamcinolone) with 18mls 0.25% bupivicaine or steroid injection with 18mls Normal saline. Pre-injection maximal (Pmax) and average (Pav) pain scores and Oswestry Disability Index (ODI) scores were obtained for each patient. Pain scores were repeated at 48 hours, 2 weeks and 8 weeks with a second ODI.

Results: A significant improvement in both Pav and Pmax were seen over the study period for both groups. There was no significant difference in either group for ΔPav. or ΔPmax at any stage of the study. Those patients who received a mixture containing bupivicaine underwent a significant improvement in their ODI in contrast to those who were injected with the saline mixture. There was also a significant difference in the ΔODI between groups.

Conclusion: Epidural bupivicaine injection appears to enhance the effect of epidural steroid injection with adequate levels of monitoring and access to specialist support. There may be a beneficial effect on the local pain pathways by the local anaeasthetic that outlasts the direct pharmacolgical effect.