Watts R W, Silagy C A
The Investigator Clinic, Port Lincoln, South Australia.
Anaesth Intensive Care. 1995 Oct;23(5):564-9. doi: 10.1177/0310057X9502300506.
The efficacy of epidural corticosteroids in the treatment of sciatica was investigated by meta-analysis of all randomized controlled trials. Eleven suitable trials of good quality were identified involving a total of 907 patients. The use of epidural (caudal or lumbar) steroid in the short-term (up to 60 days) increased the odds ratio (OR) of pain relief ( > 75% improvement) to 2.61 (95% CI 1.90-3.77) when compared with placebo. Despite some variations in trial characteristics there was little evidence of significant heterogeneity (P = 0.07). When the trials were analysed for near or total relief of pain in the short-term the OR is 2.79 (95% CI 1.92-4.06), for heterogeneity (P = 0.07). For longterm relief of pain (up to 12 months) the OR is 1.87 (95% CI 1.31-2.68). Efficacy is independent of the route of injection; for caudal epidural steroid the OR is 3.80 (95% CI 1.36-10.6) and for the lumbar epidural steroid 2.43 (95% CI 1.77-3.74). Adverse events included dural tap (2.5%), transient headache (2.3%) and a transient increase in pain (1.9%). There were no reported longterm adverse events. In conclusion we present quantitative evidence from meta-analysis of pooled data from randomized trials that epidural administration of corticosteroids is effective in the management of lumbosacral radicular pain.
通过对所有随机对照试验的荟萃分析，研究了硬膜外皮质类固醇治疗坐骨神经痛的疗效。确定了11项质量良好的合适试验，共涉及907例患者。与安慰剂相比，短期（最长60天）使用硬膜外（骶管或腰椎）类固醇可使疼痛缓解（改善>75%）的优势比（OR）提高至2.61（95%CI 1.90-3.77）。尽管试验特征存在一些差异，但几乎没有证据表明存在显著异质性（P = 0.07）。当分析试验中短期疼痛接近或完全缓解的情况时，OR为2.79（95%CI 1.92-4.06），异质性（P = 0.07）。对于长期疼痛缓解（最长12个月），OR为1.87（95%CI 1.31-2.68）。疗效与注射途径无关；骶管硬膜外类固醇的OR为3.80（95%CI 1.36-10.6），腰椎硬膜外类固醇的OR为2.43（95%CI 1.77-3.74）。不良事件包括硬膜穿破（2.5%）、短暂性头痛（2.3%）和疼痛短暂加重（1.9%）。未报告长期不良事件。总之，我们通过对随机试验汇总数据的荟萃分析提供了定量证据，表明硬膜外注射皮质类固醇在管理腰骶部神经根性疼痛方面是有效的。
