A Randomized Comparative Trial of Targeted Steroid Injection via Epidural Catheter vs Standard Transforaminal Epidural Injection for the Treatment of Unilateral Cervical Radicular Pain: Six-Month Results
| Autor: | Masaru Teramoto, A. Michael Henrie, Fabio Salazar, Richard Kendall, Russell Petersen, Erica F Bisson, Zachary L McCormick, Shellie Cunningham, Beau P. Sperry, Aaron Conger |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Steroid injection Triamcinolone acetonide Catheters medicine.medical_treatment Injections Epidural Pain Refractory Medicine Humans Prospective Studies Radiculopathy Dexamethasone business.industry Epidural steroid injection General Medicine Numeric Pain Scale Comparative trial medicine.disease Anesthesiology and Pain Medicine Treatment Outcome Radicular pain Anesthesia Female Steroids Neurology (clinical) business medicine.drug |
| Zdroj: | Pain medicine (Malden, Mass.). 21(10) |
| ISSN: | 1526-4637 |
| Popis: | Objectives Compare the effectiveness of catheter-directed cervical interlaminar epidural steroid injection (C-CIESI) with triamcinolone to cervical transforaminal steroid injection (CTFESI) with dexamethasone for the treatment of refractory unilateral radicular pain. Design Prospective, randomized, comparative trial. Methods Primary outcome: proportion of participants with ≥50% numeric rating scale pain score reduction from baseline “dominant pain” (the greater of arm vs neck) at one month postinjection. Secondary outcomes: ≥30% Neck Disability Index (NDI-5) reduction and Patient Global Impression of Change (PGIC) response indicating “much improved” or “very much improved.” Results One hundred twenty participants (55.6% females, 52.3 ± 12.5 years of age, BMI 28.2 ± 6.5 kg/m2), were enrolled. The proportions of participants who experienced ≥50% pain reduction at one, three, and six months were 68.5% (95% CI = 54.9–79.5%), 59.3% (95% CI = 45.7–71.6%), and 60.8% (95% CI = 46.7–73.2%), respectively, in the C-CIESI group compared with 49.1% (95% CI = 36.4–62.0%), 46.4% (95% CI = 33.8–59.6%), and 51.9% (95% CI = 38.4–65.2%), respectively, in the CTFESI group. The between-group difference at one month was significant (P = 0.038). The proportions of participants who experienced a ≥30% NDI-5 score improvement were 64.0% (95% CI = 49.8–76.1%) and 54.9% (95% CI = 41.1–68.0%) in the C-CIESI and CTFESI groups (P = 0.352). Participants reported similar PGIC improvement in both groups: At six months, 53.2% (95% CI 38.9–67.1%) and 54.5% (95% CI = 39.7–68.7%) of the C-CIESI and CTFESI groups reported being “much improved” or “very much improved,” respectively (P = 0.897). Conclusions Both C-CIESI with triamcinolone and CTFESI with dexamethasone are effective in reducing pain and disability associated with refractory unilateral cervical radiculopathy in a substantial proportion of participants for at least six months. |
| Databáze: | OpenAIRE |
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