Cargando…

Ultrasound versus fluoroscopy-guided caudal epidural steroid injection for the treatment of chronic low back pain with radiculopathy: A randomised, controlled clinical trial

BACKGROUND AND AIMS: Caudal epidural steroid administration is an effective treatment for chronic low back pain (LBP). Fluoroscopy guidance is the gold standard for pain procedures. Ultrasound guidance is recently being used in pain clinic procedures. We compared the fluoroscopy guidance and ultraso...

Descripción completa

Detalles Bibliográficos
Autores principales: Hazra, Arindam Kumar, Bhattacharya, Dipasri, Mukherjee, Sayantan, Ghosh, Santanu, Mitra, Manasij, Mandal, Mohanchandra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4910477/
https://www.ncbi.nlm.nih.gov/pubmed/27330199
http://dx.doi.org/10.4103/0019-5049.183391
_version_ 1782438016938147840
author Hazra, Arindam Kumar
Bhattacharya, Dipasri
Mukherjee, Sayantan
Ghosh, Santanu
Mitra, Manasij
Mandal, Mohanchandra
author_facet Hazra, Arindam Kumar
Bhattacharya, Dipasri
Mukherjee, Sayantan
Ghosh, Santanu
Mitra, Manasij
Mandal, Mohanchandra
author_sort Hazra, Arindam Kumar
collection PubMed
description BACKGROUND AND AIMS: Caudal epidural steroid administration is an effective treatment for chronic low back pain (LBP). Fluoroscopy guidance is the gold standard for pain procedures. Ultrasound guidance is recently being used in pain clinic procedures. We compared the fluoroscopy guidance and ultrasound guidance for caudal epidural steroid injection with respect to the time needed for correct placement of the needle and clinical effectiveness in patients with chronic LBP. METHODS: Fifty patients with chronic LBP with radiculopathy, not responding to conventional medical management, were randomly allocated to receive injection depot methyl prednisolone (40 mg) through caudal route either using ultrasound guidance (Group U, n = 25) or fluoroscopy guidance (Group F, n = 25). Pre-procedural visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were noted. During the procedure, the time needed for correct placement of needle was observed. Adverse events, if any, were also noted. All patients were followed up for next 2 months to evaluate Visual Analogue Scale (VAS) score and ODI at the 2(nd) week and again at the end of 1(st) and 2(nd) month. RESULTS: The needle-placement time was less using ultrasound guidance as compared to fluoroscopy guidance (119 ± 7.66 vs. 222.28 ± 29.65 s, respectively, P < 0.001). Significant reduction in VAS score and ODI (clinical improvement) was noted in the follow-up time points and comparable between the groups at all time points. CONCLUSION: Ultrasound guidance can be a safe alternative tool for achieving faster needle placement in caudal epidural space. Clinical effectiveness (reduction of VAS and ODI scores) remains comparable between both the techniques.
format Online
Article
Text
id pubmed-4910477
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher Medknow Publications & Media Pvt Ltd
record_format MEDLINE/PubMed
spelling pubmed-49104772016-06-17 Ultrasound versus fluoroscopy-guided caudal epidural steroid injection for the treatment of chronic low back pain with radiculopathy: A randomised, controlled clinical trial Hazra, Arindam Kumar Bhattacharya, Dipasri Mukherjee, Sayantan Ghosh, Santanu Mitra, Manasij Mandal, Mohanchandra Indian J Anaesth Original Article BACKGROUND AND AIMS: Caudal epidural steroid administration is an effective treatment for chronic low back pain (LBP). Fluoroscopy guidance is the gold standard for pain procedures. Ultrasound guidance is recently being used in pain clinic procedures. We compared the fluoroscopy guidance and ultrasound guidance for caudal epidural steroid injection with respect to the time needed for correct placement of the needle and clinical effectiveness in patients with chronic LBP. METHODS: Fifty patients with chronic LBP with radiculopathy, not responding to conventional medical management, were randomly allocated to receive injection depot methyl prednisolone (40 mg) through caudal route either using ultrasound guidance (Group U, n = 25) or fluoroscopy guidance (Group F, n = 25). Pre-procedural visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were noted. During the procedure, the time needed for correct placement of needle was observed. Adverse events, if any, were also noted. All patients were followed up for next 2 months to evaluate Visual Analogue Scale (VAS) score and ODI at the 2(nd) week and again at the end of 1(st) and 2(nd) month. RESULTS: The needle-placement time was less using ultrasound guidance as compared to fluoroscopy guidance (119 ± 7.66 vs. 222.28 ± 29.65 s, respectively, P < 0.001). Significant reduction in VAS score and ODI (clinical improvement) was noted in the follow-up time points and comparable between the groups at all time points. CONCLUSION: Ultrasound guidance can be a safe alternative tool for achieving faster needle placement in caudal epidural space. Clinical effectiveness (reduction of VAS and ODI scores) remains comparable between both the techniques. Medknow Publications & Media Pvt Ltd 2016-06 /pmc/articles/PMC4910477/ /pubmed/27330199 http://dx.doi.org/10.4103/0019-5049.183391 Text en Copyright: © Indian Journal of Anaesthesia http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution NonCommercial ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Hazra, Arindam Kumar
Bhattacharya, Dipasri
Mukherjee, Sayantan
Ghosh, Santanu
Mitra, Manasij
Mandal, Mohanchandra
Ultrasound versus fluoroscopy-guided caudal epidural steroid injection for the treatment of chronic low back pain with radiculopathy: A randomised, controlled clinical trial
title Ultrasound versus fluoroscopy-guided caudal epidural steroid injection for the treatment of chronic low back pain with radiculopathy: A randomised, controlled clinical trial
title_full Ultrasound versus fluoroscopy-guided caudal epidural steroid injection for the treatment of chronic low back pain with radiculopathy: A randomised, controlled clinical trial
title_fullStr Ultrasound versus fluoroscopy-guided caudal epidural steroid injection for the treatment of chronic low back pain with radiculopathy: A randomised, controlled clinical trial
title_full_unstemmed Ultrasound versus fluoroscopy-guided caudal epidural steroid injection for the treatment of chronic low back pain with radiculopathy: A randomised, controlled clinical trial
title_short Ultrasound versus fluoroscopy-guided caudal epidural steroid injection for the treatment of chronic low back pain with radiculopathy: A randomised, controlled clinical trial
title_sort ultrasound versus fluoroscopy-guided caudal epidural steroid injection for the treatment of chronic low back pain with radiculopathy: a randomised, controlled clinical trial
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4910477/
https://www.ncbi.nlm.nih.gov/pubmed/27330199
http://dx.doi.org/10.4103/0019-5049.183391
work_keys_str_mv AT hazraarindamkumar ultrasoundversusfluoroscopyguidedcaudalepiduralsteroidinjectionforthetreatmentofchroniclowbackpainwithradiculopathyarandomisedcontrolledclinicaltrial
AT bhattacharyadipasri ultrasoundversusfluoroscopyguidedcaudalepiduralsteroidinjectionforthetreatmentofchroniclowbackpainwithradiculopathyarandomisedcontrolledclinicaltrial
AT mukherjeesayantan ultrasoundversusfluoroscopyguidedcaudalepiduralsteroidinjectionforthetreatmentofchroniclowbackpainwithradiculopathyarandomisedcontrolledclinicaltrial
AT ghoshsantanu ultrasoundversusfluoroscopyguidedcaudalepiduralsteroidinjectionforthetreatmentofchroniclowbackpainwithradiculopathyarandomisedcontrolledclinicaltrial
AT mitramanasij ultrasoundversusfluoroscopyguidedcaudalepiduralsteroidinjectionforthetreatmentofchroniclowbackpainwithradiculopathyarandomisedcontrolledclinicaltrial
AT mandalmohanchandra ultrasoundversusfluoroscopyguidedcaudalepiduralsteroidinjectionforthetreatmentofchroniclowbackpainwithradiculopathyarandomisedcontrolledclinicaltrial