title: Effect of High-Volume Injectate in Lumbar Transforaminal Epidural Steroid Injections: A Randomized, Active Control Trial.
abstract: BACKGROUND
  There have been many studies proving the effectiveness of lumbar transforaminal epidural steroid injections (TFESIs) for the treatment of radicular pain. Dexamethasone has been suggested as an alternative to particulate steroids. However, no controlled trials have investigated the effect of different injected volumes for a same dose of dexamethasone.
  
  
  OBJECTIVE
  To compare the effects of a high-volume injectate with those of a low-volume injectate using the same dose of dexamethasone for 2 groups in lumbar TFESI.
  
  
  METHODS
  A prospective, randomized, active control trial.
  
  
  METHODS
  The outpatient clinic of a single academic medical center.
  
  
  METHODS
  A total of 66 patients were randomized to receive lumbar transforaminal epidural dexamethasone injections with either a low-volume injectate (3 mL, N = 30) or a high-volume injectate (8 mL, N = 32). The primary outcome measures for this study were the incidence of the patients achieving meaningful pain relief and a reduction on the Visual Analogue Scale (VAS, range 0-100) at 4 weeks after the procedure. The definition of "meaningful pain relief" was ≥ 50% from baseline. The secondary outcomes included the Roland-Morris Disability Questionnaire (RMDQ, range 0-24) score and adverse effects. The outcomes were assessed 4 weeks after the procedure.
  
  
  RESULTS
  Four weeks after the procedure, in the DL8 group, the incidence of achieving meaningful pain relief was higher compared with DL3 group (19, 59.4% vs. 9, 30%, P = 0.024). Both groups demonstrated a significant improvement in their VAS and RMDQ scores (P < 0.05). The VAS of the high-volume injectate group (DL8) was significantly lower than that of the low-volume injectate group (DL3) (33.3 ± 25 vs. 46.3 ± 25, P = 0.036). There was no significant difference in the RMDQ score between the 2 groups.
  
  
  CONCLUSIONS
  We enrolled a small number of patients and did not check the long-term outcomes.
  
  
  CONCLUSIONS
  Injectate at a volume of 8 mL was more effective than injectate at a volume of 3 mL for radicular pain in a lumbar transforaminal steroid injection, although both of the injectates contained the same dose of dexamethasone.
authors.affiliation: School of Medicine, Ewha Woman's University, Seoul, Korea.
authors.forename: Eun Hee
authors.initials: EH
authors.lastname: Chun
authors.forename: Hahck Soo
authors.initials: HS
authors.lastname: Park
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D001416:Back Pain / Q000188:drug therapy*; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010147:Pain Measurement; D011446:Prospective Studies; D013256:Steroids / Q000008:administration & dosage* / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D013256:Steroids; D003907:Dexamethasone