title: A pilot study of the dose-response of caudal methylprednisolone with levobupivacaine in chronic lower back pain.
abstract: The question as to what constitutes the ideal epidural steroid injection remains unresolved. We performed a prospective, randomised, double-blind, AB/BA 2 × 2 crossover study of caudal 40 vs 80 mg methylprednisolone acetate (in 20 ml levobupivacaine 0.125%) in outpatients with chronic low back pain. Data from 33 participants were analysed. The Oswestry Disability Index improved in both dose groups over time following injection. However, a statistically significant improvement was only observed in the 40 mg methylprednisolone acetate group (40 mg: p < 0.001; 80 mg: p = 0.33). There was no statistically significant difference between the dose groups in change in the Oswestry Disability Index with respect to time. Methylprednisolone acetate 40 mg appears to be as effective as 80 mg in improving disability associated with chronic low back pain, and should be considered in preference to the 80 mg dose for outpatients with chronic low back pain attending for repeat caudal steroid injection.
authors.affiliation: Department of Anesthesia, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK. rob.mccahon@nottingham.ac.uk
authors.forename: R A
authors.initials: RA
authors.lastname: McCahon
authors.forename: A
authors.initials: A
authors.lastname: Ravenscroft
authors.forename: V
authors.initials: V
authors.lastname: Hodgkinson
authors.forename: R
authors.initials: R
authors.lastname: Evley
authors.forename: J
authors.initials: J
authors.lastname: Hardman
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D002908:Chronic Disease; D004185:Disability Evaluation; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D004812:Epidemiologic Methods; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D000077554:Levobupivacaine; D017116:Low Back Pain / Q000188:drug therapy* / Q000534:rehabilitation; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077555:Methylprednisolone Acetate; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; D005938:Glucocorticoids; D000077555:Methylprednisolone Acetate; D000077554:Levobupivacaine; D008775:Methylprednisolone; D002045:Bupivacaine