title: Increased dose of betamethasone for transforaminal epidural steroid injections is not associated with superior pain outcomes at 4 weeks.
abstract: BACKGROUND
  Fluoroscopically guided transforaminal epidural steroid injections (FG-TFESIs) have been shown to provide both immediate and long-term improvement in patient's self-reported pain. Administration of the lowest possible dose of epidural betamethasone is desired to minimize side effects while maintaining efficacy. We hypothesize that a 3 mg or a 6 mg dose of betamethasone will demonstrate equivalent analgesic properties.
  
  
  OBJECTIVE
  To compare the analgesic efficacy of 3 mg and a 6 mg dose of betamethasone for use in FG-TFESI.
  
  
  METHODS
  Retrospective evaluation.
  
  
  METHODS
  Academic outpatient pain center.
  
  
  METHODS
  One hundred fifty-eight patients underwent FG-TFESI for lumbar back pain between 2012 and 2013. Depending on the date of service, a dose of 3 mg or a dose of 6 mg betamethasone was used in the single level unilateral TFESI. Opioid consumption and NRS pain score were analyzed pre-procedurally and at a clinic visit 4 weeks post-procedurally.
  
  
  RESULTS
  Changes in numerical rating scale (NRS) pain score (-1.21 +' 2.61 vs. -0.81 +' 2.40 respectively, P = 0.17) and changes in opioid consumption as measured in oral morphine equivalents (-2.94 +' 16.4 mg vs. -2.93 +' 14.8 mg, P = 0.17) were statistically equivalent between both groups. Intergroup sub-analysis of those with > 50% reduction in baseline VRS {sp} pain score was not different (15.2% vs. 34%, P = 0.56), and the proportion with a VRS pain score < 3 were similar (24.5% vs. 23.8%, P = 0.92).
  
  
  CONCLUSIONS
  Potential selection bias inherent with study design.
  
  
  CONCLUSIONS
  Reduction in NRS pain scores and narcotic usage at 4 weeks after FG-TFESI were statistically equivalent between patients who received 3 mg or 6 mg of betamethasone, suggesting that a lower steroid dose has similar analgesic efficacy. IRB Number: Cedars Sinai Medical Center Institutional Review Board Pro00031594
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Waylan
authors.initials: W
authors.lastname: Wong
authors.forename: Dermot P
authors.initials: DP
authors.lastname: Maher
authors.forename: Daniel
authors.initials: D
authors.lastname: Iyayi
authors.forename: Raul
authors.initials: R
authors.lastname: Lopez
authors.forename: Bahman
authors.initials: B
authors.lastname: Shamloo
authors.forename: Howard
authors.initials: H
authors.lastname: Rosner
authors.forename: Roya
authors.initials: R
authors.lastname: Yumul
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001623:Betamethasone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D017116:Low Back Pain / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects* / Q000379:methods / Q000639:trends; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D013256:Steroids; D001623:Betamethasone