Lumbar radiculopathy: treatment with selective lumbar nerve blocks--comparison of effectiveness of triamcinolone and betamethasone injectable suspensions.
OBJECTIVE
To retrospectively determine if there is a difference in the effectiveness of triamcinolone acetonide injectable suspension versus betamethasone sodium phosphate and betamethasone acetate injectable suspension in the treatment of radiculopathy and low back pain with selective lumbar nerve blocks.


METHODS
This retrospective study was approved by the institutional review board and was HIPAA compliant; informed consent was not required. Charts and self-reported pain score evaluations were retrospectively reviewed in 114 patients (56 men, 58 women; age range, 36-84 years; mean age, 60 years) treated for radiculopathy from 1997 to 2003 with 130 selective lumbar nerve blocks with triamcinolone or betamethasone. Perineural location was confirmed with fluoroscopic guidance. Forty-nine patients received a mixture of 1 mL of the triamcinolone, 40 mg/mL, and 1 mL of 0.5% bupivacaine hydrochloride. Eighty-one patients received a mixture of 1 mL of the betamethasone, 6 mg/mL, and 1 mL of 0.5% bupivacaine hydrochloride. Patients completed standardized pain evaluation sheets and compared their pain with baseline levels during 14 days after injection. Fisher exact test was used for data analysis.


RESULTS
From day 0 to 1 after the procedure, there was no statistically significant difference in improvement in low back pain and lower extremity pain between groups. On day 3, 42% of triamcinolone recipients and 58% of betamethasone recipients demonstrated improvement in low back pain (P = .04, Fisher exact test), whereas 55% of triamcinolone recipients and 57% of betamethasone recipients had lower extremity pain improvement (P = .33). On day 7, 45% of triamcinolone recipients and 58% of betamethasone recipients had improvement in low back pain (P = .38), whereas 52% of triamcinolone recipients and 57% of betamethasone recipients had improvement in lower extremity pain (P = .69). On day 14, 42% of triamcinolone recipients and 53% of betamethasone recipients had improvement in low back pain (P = .26), whereas 49% of triamcinolone recipients and 55% of betamethasone recipients had improvement in lower extremity pain (P = .69).


CONCLUSIONS
Selective nerve root blocks with betamethasone and triamcinolone reduced low back pain and lower extremity pain, although there was no significant difference in effectiveness between the two.
Blankenbaker
Donna G
DG
Department of Radiology, Division of Musculoskeletal Imaging, University of Wisconsin Medical School, Madison, WI 53792-3252, USA. dg.blankenbaker@hosp.wisc.edu
De Smet
Arthur A
AA
Stanczak
Jeffrey D
JD
Fine
Jason P
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001623:Betamethasone / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007267:Injections; D017116:Low Back Pain / Q000188:drug therapy*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D011843:Radiculopathy / Q000188:drug therapy*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D013535:Suspensions; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D013535:Suspensions; D001623:Betamethasone; D014222:Triamcinolone Acetonide; D002045:Bupivacaine