A Prospective Randomized Comparative Trial of Targeted Steroid Injection Via Epidural Catheter Versus Standard C7-T1 Interlaminar Approach for the Treatment of Unilateral Cervical Radicular Pain
Autor: | Mark C. Kendall, David R. Walega, Geeta Nagpal, Dost Khan, Mikhail Zhukalin, Zachary L McCormick, Ariana M. Nelson, Robert J. McCarthy, Meghan Bhave |
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Rok vydání: | 2016 |
Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Injections Epidural Thoracic Vertebrae law.invention 03 medical and health sciences 0302 clinical medicine Catheters Indwelling Randomized controlled trial 030202 anesthesiology law medicine Humans Single-Blind Method Prospective Studies Prospective cohort study Radiculopathy Neck pain Neck Pain Epidural steroid injection business.industry General Medicine Middle Aged medicine.disease Confidence interval Surgery Catheter Anesthesiology and Pain Medicine Radicular pain McGill Pain Questionnaire Anesthesia Cervical Vertebrae Female Steroids medicine.symptom business 030217 neurology & neurosurgery |
Zdroj: | Regional anesthesia and pain medicine. 42(1) |
ISSN: | 1532-8651 |
Popis: | Background and Objectives No study has compared cervical interlaminar epidural steroid injection (CIESI) with epidural catheter advancement to the side and level of pathology versus standard C7-T1 CIESI. This study investigated whether cervical radicular pain is more effectively treated by CIESI with a targeted epidural catheter versus a standard C7-T1 approach. Methods Prospective, randomized, single-blinded trial. Primary outcome: Numerical Rating Scale (NRS) pain at 1 month. Secondary outcomes: Oswestry Neck Disability Index (ONDI), Pain Disability Index (PDI), McGill Pain Questionnaire (MPQ), Patient Global Impression of Change (PGIC), daily morphine equivalents (DME), and Medication Quantification Scale (MQS) III scores. Results Seventy-six participants with a median age of 48 years (IQR, 40–56 years), 59% female, with C4 (n = 2), C5 (n = 27), or C6 (n = 47) radicular pain were enrolled. At 1 month in the catheter and no catheter groups, respectively: 26 (72%, 95% confidence interval [CI], 57%–87%) and 23 (60%; 95% CI, 45%–75%) participants reported 50% or greater NRS reduction; 24 (67%; 95% CI, 52%–84%) and 23 (58%; 95% CI, 42%–73%) participants reported 30% or greater ONDI reduction. There were no group differences in median NRS, ONDI, PDI, MPQ, PGIC, DME, or MQSIII scores (P > 0.05). Intergroup differences were not observed at any follow-up interval. Conclusions This trial showed no significant difference in clinical outcomes with CIESI using a targeted epidural catheter compared to a standard C7-T1 approach for the treatment of unilateral cervical radicular pain at the C5 or C6 level. Both techniques were associated with clinically meaningful improvement across outcome domains of pain, function, disability, and medication use. These effects persisted to 6-month follow-up. The study was registered at Clinical Trials.gov (NCT02095197). |
Databáze: | OpenAIRE |
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