Chow Robert, Ng Jessica, Wood Melanie, Yanez David, He Zili, Rajput Kanishka
Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA.
Pain Pract. 2025 Jan;25(1):e13410. doi: 10.1111/papr.13410. Epub 2024 Sep 20.
Epidural steroid injections (ESIs) are commonly used as a treatment for lumbar radiculopathy. Currently, most research on comparative efficacy of various steroids in epidural steroid injections is focused on transforaminal ESIs (TFESIs). Through this study, we aimed to compare various steroid doses with or without local anesthetic in interlaminar ESIs (ILESIs).
We reviewed charts for all adult patients who received ILESIs identified by CPT code 62323 between January 2017 to April 2021. Baseline demographic data including age, sex, BMI, and smoking status were recorded. NRS pain scores before the injection and percentage of pain relief at 1-month follow-up were recorded. We compared percentage of patients reporting pain relief at 1 month follow-up of low-dose dexamethasone alone (5 mg), to low-dose dexamethasone mixed with local anesthetic, and to high-dose dexamethasone (10 mg) mixed with local anesthetic, specifically for ILESIs.
Data were available for 311 patients. There was no significant difference in pain relief between the 3 groups at 1 month follow-up. The majority of patients had moderate to significant improvement in pain, supporting the use of ILESIs. Moreover, low-dose steroid with local anesthetic was found to be as efficacious as high-dose steroid alone. Although not statistically significant, the addition of local anesthetic to low-dose or high-dose steroid increased the percentage of patients reporting moderate to significant pain relief.
ILESIs with non-particulate steroids provide moderate to significant pain improvement in the short term, with low-dose steroid mixed with local anesthetic being as efficacious as a high-dose steroid.
硬膜外类固醇注射（ESI）常用于治疗腰椎神经根病。目前，关于硬膜外类固醇注射中各种类固醇比较疗效的大多数研究都集中在经椎间孔硬膜外类固醇注射（TFESI）上。通过本研究，我们旨在比较在椎板间硬膜外类固醇注射（ILESI）中使用或不使用局部麻醉剂的各种类固醇剂量。
我们回顾了2017年1月至2021年4月期间接受CPT编码62323识别的ILESI的所有成年患者的病历。记录包括年龄、性别、BMI和吸烟状况在内的基线人口统计学数据。记录注射前的NRS疼痛评分和1个月随访时的疼痛缓解百分比。我们比较了单独使用低剂量地塞米松（5mg）、低剂量地塞米松与局部麻醉剂混合以及高剂量地塞米松（10mg）与局部麻醉剂混合的患者在1个月随访时报告疼痛缓解的百分比，专门针对ILESI。
有311名患者的数据可用。在1个月随访时，3组之间的疼痛缓解没有显著差异。大多数患者的疼痛有中度至显著改善，支持ILESI的使用。此外，发现低剂量类固醇与局部麻醉剂一样有效。虽然没有统计学意义，但在低剂量或高剂量类固醇中添加局部麻醉剂增加了报告中度至显著疼痛缓解的患者百分比。
使用非颗粒状类固醇的ILESI在短期内可使疼痛得到中度至显著改善，低剂量类固醇与局部麻醉剂混合与高剂量类固醇一样有效。
