scholarly journals Correlation of Perfusion Index Change and Analgesic Efficacy in Transforaminal Block for Lumbosacral Radicular Pain

2019 ◽  
Vol 8 (1) ◽  
pp. 51 ◽  
Author(s):  
Jin Young Lee ◽  
Eung Don Kim ◽  
Yoo Na Kim ◽  
Ji Seob Kim ◽  
Woo Seog Sim ◽  
...  
Keyword(s):  
Area Under The Curve ◽  
Analgesic Efficacy ◽  
Epidural Injection ◽  
Pain Reduction ◽  
Radicular Pain ◽  
Perfusion Index ◽  
Objective Method ◽  
Peripheral Perfusion ◽  
Index Change ◽  
Transforaminal Epidural Injection

Transforaminal epidural injection is used to treat radicular pain. However, there is no objective method of assessing pain relief following transforaminal injection. Perfusion index is a metric for monitoring peripheral perfusion status. This study evaluates the correlation between perfusion index change and analgesic efficacy in transforaminal blocks for lumbosacral radicular pain. We retrospectively analyzed data of 100 patients receiving transforaminal block for lumbosacral radicular pain. We assessed perfusion index before treatment and at 5, 15, and 30 min following the block. We defined responders (group R) and non-responders (group N) as those with ≥50% and <50% pain reduction, respectively, 30 min following block. Clinical data and perfusion index of the groups were analyzed. Ninety-two patients were examined, of whom 57 (61.9%) and 35 (38.0%) patients reported ≥50% and <50% pain reduction, respectively. Group R had a significantly higher perfusion index change ratio 5 min following the block (p = 0.029). A perfusion index change ratio of ≥0.27 was observed in group R (sensitivity, 75.4%; specificity, 51.4%; AUC (area under the curve), 0.636; p = 0.032). A perfusion index change ratio of ≥0.27 at 5 min after block is associated with, but does not predict improvement in, pain levels following lumbosacral transforaminal block.

One-year results from a randomized comparative trial of targeted steroid injection via epidural catheter versus standard transforaminal epidural injection for the treatment of unilateral cervical radicular pain

2021 ◽  
pp. rapm-2021-102514
Author(s):  
Aaron Conger ◽  
Richard W Kendall ◽  
Beau P Sperry ◽  
Russell Petersen ◽  
Fabio Salazar ◽  
...  
Keyword(s):  
Rating Scale ◽  
Steroid Injection ◽  
Neck Disability Index ◽  
Comparative Trial ◽  
Epidural Injection ◽  
Pain Reduction ◽  
Radicular Pain ◽  
Patient Global Impression ◽  
Neck Disability ◽  
Global Impression Of Change

ObjectivesThe objective of this study was to evaluate the long-term effectiveness of catheter-directed cervical interlaminar epidural steroid injection with triamcinolone compared with cervical transforaminal steroid injection with dexamethasone for the treatment of refractory unilateral radicular pain.DesignProspective, randomized, comparative trial.MethodsThe primary outcome was the proportion of participants with ≥50% Numeric Rating Scale ‘dominant pain’ (the greater of arm vs neck) reduction from baseline. Secondary outcomes included ≥30% Neck Disability Index reduction and Patient Global Impression of Change response indicating ‘much improved’ or ‘very much improved’.ResultsData from 117 participants (55.6% women; 52.3±12.5 years of age; body mass index, 28.2±6.5 kg/m2) were analyzed. The proportion of participants who experienced ≥50% pain reduction at 1 month, 3 months, and 6 months has been previously reported. At 1 year, 61.2% (95% CI, 46.9% to 73.9%) of the catheter group compared with 51.9% (95% CI, 38.4% to 65.2%) of the transforaminal group reported ≥50% ‘dominant’ pain reduction (p=0.35). The proportion of participants who experienced ≥30% improvement in Neck Disability Index score was 60.4% (95% CI, 45.9% to 73.3%) and 47.1% (95% CI, 33.7% to 60.8%) in the catheter and transforaminal groups (p=0.18). Patient Global Impression of Change improvement was similar in both groups: 60.5% (95% CI, 44.2% to 74.8%) and 57.5% (95% CI, 41.7% to 71.9%) of the catheter and transforaminal groups reported being ‘much improved’ or ‘very much improved’, respectively (p=0.79).ConclusionBoth cervical catheter-directed interlaminar epidural injection and cervical transforaminal steroid injection were effective in reducing pain and disability in the majority of participants with refractory unilateral cervical radiculopathy for up to 1 year.

scholarly journals A comparative evaluation of kambin’s triangle approach versus safe triangle approach for lumbar transforaminal epidural injection in patients with lumbar radiculopathy - A prospective, randomized, double blind study

2021 ◽  
Vol 12 (8) ◽  
pp. 41-47
Author(s):  
Rajasree Biswas ◽  
Arpita Choudhury ◽  
Dipasri Bhattacharya ◽  
Sabyasachi Nandy
Keyword(s):  
Epidural Injection ◽  
Radicular Pain ◽  
Spinal Nerve ◽  
Double Blind Study ◽  
Lumbar Radiculopathy ◽  
Short Term ◽  
Double Blind ◽  
Transforaminal Approach ◽  
Transforaminal Epidural Injection ◽  
The Relationship

Background: Epidural injection of steroid and local anaesthetic is a common modality for management of radicular pain. Transforaminal approach is preferred for epidural injection in case of radiculopathy. Aims and Objectives: To compare the effect of the Kambin’s triangle and subpedicular approaches of transforaminal epidural injection (TFEI) in patients of lumbar radiculopathy. Materials and Methods: Forty patients with lumbar radicular pain were enrolled and randomly assigned to each group (Group K for Kambin’s triangle approach and Group S for subpedicular approach). All procedures were performed under fluroscopic guidance. The frequency of complications during the procedure and the effect of TFEI at 2 and 4 weeks after the procedure between the two groups were compared. Short-term outcomes were measured using a visual Analog scale (VAS). Multiple logistic regression analyses were performed to evaluate the relationship between possible outcome predictors and the therapeutic effect. Result: VAS was improved 2 weeks after the injection and continued to improve until 4 weeks in both groups. There were no statistical differences in changes of VAS between these two groups. Spinal nerve pricking occurred in one case of the subpedicular and in none of the cases of the Kambin’s triangle approach (p<0.05). Conclusion: Kambin’s triangle approach is as efficacious as the subpedicular approach for short-term effect and offers considerable advantages (i.e., less spinal nerve pricking during procedure). So, Kambin’s triangle approach may be an alternative method for TFEI in cases where needle tip positioning in the anterior epidural space is difficult.

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