Joo Eun Young, Koh Won Uk, Choi Seong-Soo, Choi Jae-Hyung, Ahn Ho-Soo, Yun Hye Joo, Shin Jin-Woo
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Pain Physician. 2017 Jan-Feb;20(1):E107-E114.
Chronic lower back pain with or without radiculopathy represents an important medical, social, and economic problem. Many treatment modalities and techniques, including surgery and epidural administration of steroids, have been used to manage this pain. Hypertonic saline, which has been used as an adjunct to percutaneous epidural adhesiolysis, can also be injected via a transforaminal approach in expectation of longer-lasting effects.
This study aimed to determine the effect of adding hypertonic saline to conventional transforaminal epidural steroid injections (TFEI) to provide pain relief for chronic radiculopathy patients.
A retrospective study.
Pain clinic of a university hospital.
Between January 2010 and December 2013, the medical records of 246 patients (94 in the hypertonic group, 153 in the control group) who received transforaminal epidural block were reviewed and analyzed. The hypertonic group received 10% sodium chloride solution added to lidocaine, triamcinolone, and hyaluronidase. Outcomes on pain reduction were measured using a numerical rating scale (NRS) and the responder rate at baseline, one, 3, and 6 months after procedure.
The estimated difference in NRS scores from baseline throughout a 6-month follow-up period in the hypertonic group were significantly higher (P = 0.0003). The proportion of substantial responders (41.9% vs. 34.6% at one month, 40.9% vs. 26.8% at 3 months, and 33.3% vs. 14.4% at 6 months, respectively, P = 0.0058) and substantial/moderate responders (71.0% vs. 58.8% at one month, 65.6% vs. 40.4% at 3 months, and 48.4% vs. 20.3% at 6 months, respectively, P < 0.0001) were significantly higher in the hypertonic group. The Oswestry disability index (ODI) was not different between the groups (P = 0.2697).
Retrospective design without a control group.
Hypertonic saline provides more superior and longer lasting pain relieving effects when added to TFEIs.Key words: Back pain, epidural injections, epidural steroids, hypertonic saline, lumbar, radiculopathy, transforaminal.
伴有或不伴有神经根病的慢性下背痛是一个重要的医学、社会和经济问题。许多治疗方式和技术，包括手术和硬膜外注射类固醇，已被用于管理这种疼痛。高渗盐水已被用作经皮硬膜外粘连松解术的辅助药物，也可通过椎间孔途径注射，以期获得更持久的效果。
本研究旨在确定在传统椎间孔硬膜外类固醇注射（TFEI）中添加高渗盐水对慢性神经根病患者缓解疼痛的效果。
一项回顾性研究。
一所大学医院的疼痛诊所。
回顾并分析了2010年1月至2013年12月期间接受椎间孔硬膜外阻滞的246例患者（高渗组94例，对照组153例）的病历。高渗组在利多卡因、曲安奈德和透明质酸酶中加入10%氯化钠溶液。使用数字评分量表（NRS）以及术前、术后1个月、3个月和6个月时的有效率来衡量疼痛减轻的结果。
在6个月的随访期内，高渗组与基线相比NRS评分的估计差异显著更高（P = 0.0003）。高渗组中显著有效者的比例（1个月时分别为41.9%对34.6%，3个月时为40.9%对26.8%，6个月时为33.3%对14.4%，P = 0.0058）以及显著/中度有效者的比例（1个月时分别为71.0%对58.8%，3个月时为65.6%对40.4%，6个月时为48.4%对20.3%，P < 0.0001）显著更高。两组间的Oswestry功能障碍指数（ODI）无差异（P = 0.2697）。
回顾性设计且无对照组。
在TFEI中添加高渗盐水可提供更优且更持久的疼痛缓解效果。关键词：背痛、硬膜外注射、硬膜外类固醇、高渗盐水、腰椎、神经根病、椎间孔
