Cervical Epidural Steroid Drug Injection: Parasagittal approach as an alternative to the midline approach in patients with unilateral cervical radicular pain; a comparative randomized clinical trial
Publish place: The 19th Annual Congress of Medical Students of Iran
Publish Year: 1397
نوع سند: مقاله کنفرانسی
زبان: English
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شناسه ملی سند علمی:
AMSMED19_061
تاریخ نمایه سازی: 1 دی 1397
Abstract:
Background and objectives: Cervical epidural steroid injection (CESI) is one of the most commonly performed interventions in management of upper extremity radicular pain. This study was aimed to make a comparison between parasagittal interlaminar CESI (PSIL-CESI) and the classic midline interlaminar CESI (MIL-CESI) in terms of alleviation of pain and reduction of functional disability in patients with unilateral upper extremity radicular pain. Materials and methods: In a parallel randomized double-blind clinical trial with ethic code IR.SBMU.RETECH.REC.1397.163, 26 patients were allocated into two groups of 13 patients undergoing either PSIL-CESI or MIL-CESI. After confirmation of radiocontrast spread in the epidural space by fluoroscopic guidance, dexamethasone 8 mg and bupivacaine 0.125% in a volume of 5 ml were delivered to the epidural space. Evaluation of functional state and pain intensity before and 1 month after the procedure was accomplished using the neck disability index (NDI) and the numeric rating scale (NRS) respectively. Findings: Improvements in the NDI and the NRS were observed in both groups; meanwhile, improvements were more pronounced in the PSIL-CESI group as compared to the MIL-CESI group (P<0.001). With the PSIL approach the ventral spread of radiocontrast was significantly higher (38%) than with the MIL approach (0.7%) (P<0.001). All patients in PSIL group showed radiocontrast spread ipsilateral to the painful side and all patients in the MIL group showed a midline distribution of radiocontrast. Conclusion: PSIL-CESI provides superior pain relief and improvement of functional disability in patients with unilateral upper extremity radicular pain in comparison to the classic MIL-CESI.
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Authors
Seyed Masoud Hashemi
Associate Professor, Program director of Pain Fellowship, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Rohollah Valizadeh
Ph.D. Student in Epidemiology, Student Research Committee, Department of Epidemiology, Iran University of Medical Sciences, Tehran, Iran
Kasra Dehghan
Anesthesiologist, Fellowship in Pain Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran