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21KF-004
A randomized trial of transforaminal epidural injections using a high-volume injectate with or without steroids for LDH

Seung HeeYoo1, Won-joong KIM1, Rack Kyung CHUNG1,Hee Jung BAIK1, Dong Yeon KIM1, Jong In HAN1,Heeseung LEE1, Jong Wha LEE1, Sooyoung CHO1,Youn Jin KIM2, Jae Hee WOO2

1 Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea

2 Department of Anesthesiology and Pain Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea

Background
Lumbar transforaminal epidural steroid injection (L-TFESI) therapy is an effective treatment approach for radicular pain due to lumbar disc herniation (LDH). The effects of TFE injections might be influenced by the volume of the injectate, and a positive correlation has been reported between the fluid injection volume and the relief of radicular pain and low back pain.The purpose of this study was to compare the clinical effects of TFE injections with a high-volume injectate of local anesthetics (LAs) with or without steroids for managing back and lumbosacral radicular pain secondary to LDH.

Methods
A total of 54 patients were enrolled and randomly assigned to either group S or group L. In group S, 8 mL of 0.33% lidocaine with 5 mg of dexamethasone disodium phosphate was injected. In group L, 8 mL of 0.33% lidocaine was injected.
The outcome measures for this study were pain relief and reduction of functional disability at 4 weeks after the procedure.

Results
The pain scores and functional disability for each group are shown in Table 1. There were no significant differences in baseline VAS scores for back and radicular pain or RMDQ scores between the two groups, with no significant differences at 4 weeks after treatment Table 1. At 4 weeks after the procedure, both groups demonstrated a statistically significant improvement in back and radicular pain according to VAS scores and an improvement in the functional status according to RMDQ scores (P < 0.05), with no significant differences between the two groups Table 2.

Conclusion
Compared with L-TFESIs, TFE injections of LAs using a high volume of injectate showed no significant differences in pain reduction and functional disability improvement for managing back and radicular pain secondary to LDH.

(Reference)
1. Bhatia A, Flamer D, Shah PS, et al. Transforaminal Epidural Steroid Injections for Treating Lumbosacral Radicular Pain from Herniated Intervertebral Discs: A Systematic Review and Meta-Analysis. Anesthesia and analgesia 2016:122: 857-870.
2. Rabinovitch DL, Peliowski A, Furlan AD. Influence of lumbar epidural injection volume on pain relief for radicular leg pain and/or low back pain. The spine journal : official journal of the North American Spine Society 2009:9: 509-517.