title: A randomized, controlled, double-blind trial of fluoroscopic caudal epidural injections in the treatment of lumbar disc herniation and radiculitis.
abstract: METHODS
  A randomized, controlled, double-blind trial.
  
  
  OBJECTIVE
  To assess the effectiveness of fluoroscopically directed caudal epidural injections in managing chronic low back and lower extremity pain in patients with disc herniation and radiculitis with local anesthetic with or without steroids.
  
  
  BACKGROUND
  The available literature on the effectiveness of epidural injections in managing chronic low back pain secondary to disc herniation is highly variable.
  
  
  METHODS
  One hundred twenty patients suffering with low back and lower extremity pain with disc herniation and radiculitis were randomized to one of the two groups: group I received caudal epidural injections with an injection of local anesthetic, lidocaine 0.5%, 10 mL; group II patients received caudal epidural injections with 0.5% lidocaine, 9 mL, mixed with 1 mL of steroid. The Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake were utilized with assessment at 3, 6, and 12 months posttreatment.
  
  
  RESULTS
  The percentage of patients with significant pain relief of 50% or greater and/or improvement in functional status with 50% or more reduction in ODI scores was seen in 70% and 67% in group I and 77% and 75% in group II with average procedures per year of 3.8 ± 1.4 in group I and 3.6 + 1.1 in group II. However, the relief with first and second procedures was significantly higher in the steroid group. The number of injections performed was also higher in local anesthetic group even though overall relief was without any significant difference among the groups. There was no difference among the patients receiving steroids.
  
  
  CONCLUSIONS
  Caudal epidural injection with local anesthetic with or without steroids might be effective in patients with disc herniation or radiculitis. The present evidence illustrates potential superiority of steroids compared with local anesthetic at 1-year follow-up.
authors: Pain Management Center of Paducah, Paducah, KY, USA. drlm@thepainmd.com
authors: Laxmaiah
authors: L
authors: Manchikanti
authors: Vijay
authors: V
authors: Singh
authors: Kimberly A
authors: KA
authors: Cash
authors: Vidyasagar
authors: V
authors: Pampati
authors: Kim S
authors: KS
authors: Damron
authors: Mark V
authors: MV
authors: Boswell
mesh_terms: D000328:Adult; D000763:Anesthesia, Caudal / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage; D001623:Betamethasone / Q000008:administration & dosage; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007268:Injections, Epidural / Q000379:methods; D007405:Intervertebral Disc Displacement / Q000150:complications*; D008012:Lidocaine / Q000008:administration & dosage*; D017116:Low Back Pain / Q000209:etiology / Q000517:prevention & control*; D008159:Lumbar Vertebrae; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D011843:Radiculopathy / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D005938:Glucocorticoids; D001623:Betamethasone; D008012:Lidocaine; D008775:Methylprednisolone