Is the outcome of caudal epidural injections affected by patient positioning?
METHODS
A prospective, randomized controlled trial.


OBJECTIVE
To investigate the effect of the lateral decubitus position, after a caudal epidural injection, on outcome.


BACKGROUND
Caudal epidural injections are used widely in the treatment of low back pain and radicular leg pain. Various measures have been used to improve the efficacy of these injections in previous studies. Our aim was to investigate the effect of the lateral decubitus position, after administering a caudal epidural injection, on outcome.


METHODS
Fifty-seven patients undergoing caudal epidural injection for low back pain associated with radicular leg pain were randomly allocated into 2 groups. Group 1 (treatment group) had 28 patients who were placed in the lateral decubitus position after injection. Group 2 (control group) had 29 patients who were laid supine after injection. Patients were assessed before injection using the Verbal Pain Score (VPS) and the Oswestry Disability Index (ODI). They were reassessed after 6 weeks using the same outcome measures.


RESULTS
Both groups demonstrated improvement after injection. The degree of improvement in the VPS was significantly greater in group 1 compared with group 2 (P = 0.00007). The degree of improvement in the ODI was not statistically significant (P = 0.14).


CONCLUSIONS
Laying a patient on the side of their leg pain after a caudal epidural injection has a beneficial effect on the degree of pain relief. We recommend that this simple and safe maneuver be introduced routinely after administering a caudal epidural injection, to aid in the eventual outcome of a potentially difficult clinical problem.
Department of Trauma and Orthopaedic Surgery, Princess Alexandra Hospital NHS Trust, Hamstel Road, Harlow, Essex, United Kingdom. daoudmakki@hotmail.com
Daoud
D
Makki
Danyal H
DH
Nawabi
Randhir
R
Francis
A Rami
AR
Hamed
Ahmed A
AA
Hussein
D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D004185:Disability Evaluation; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D017116:Low Back Pain / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D056888:Patient Positioning; D011187:Posture / Q000502:physiology; D011843:Radiculopathy / Q000188:drug therapy / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone; D002045:Bupivacaine