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The immediate response of low back pain and sciatica to Fluoroscopically guided Lumbar Epidural Steroid and Bupivicaine Administration 2006

Interventional Spine

Rex B Jennings, DO, Non ASSR Member
William E Rothfus, MD, ASSR Member
Walter S Bartynski, MD, ASSR Member

Scientific Paper

Purpose

Lumbar epidural steroid injection (LESI) is commonly administered to patients for treatment of lower back pain, spinal stenosis and sciatica. Most studies have focused on the mid to long term outcome of pain relief related to the steroid administration. Pain reduction is occasionally reported immediately after the LESI procedure, even before the patient leaves the procedure suite. Pain reduction identified at this time was presumably related to the effects of the local anesthetic vehicle. The purpose of this study was to evaluate the immediate effects of standard lumbar epidural steroid and bupivicaine administration on back pain and leg pain after fluoroscopically guided LESI.

Methods & Materials

The physician record, spine nursing record and procedure imaging were retrospectively evaluated in 96 LESI's performed in 67 patients treated for back pain and/or radiculopathy with standard fluoroscopically guided lumbar epidural steroid (methylprednisilone 80mg) and bupivicaine ( 0.25-0.5%; 2-3 cc) administration. Forty six patients had a single LESI and 21 patients had multiple LESI treatments. Nursing documentation of the patient's pre and post procedure pain scale level were identified and tabulated. Post procedure pain level was typically recorded 15 minutes after procedure completion. Pain reduction after steroid/bupivicaine administration was graded as percent reduction of the pre procedure pain level. Pain improvement was grouped into 5 equally divided categories based on percent pain reduction.

Results

Overall, in 54 (56%) injections, patients achieved 80-100% immediate pain relief with an additional 11 (11.5%) resulting in 60-80% improvement within 15 minutes after LESI. In 48 (50%) of these injections, patients were completely pain free after the LESI procedure. Results were slightly better for patients who received multiple injections (62%) as compared to a single LESI treatment (50%).

In 11 of 21 patients who received multiple LESI treatments, a consistent pain improvement response was noted. In 3 of 21 patients, pain response improved after the initial injection. In 7 patients, pain response was variable over multiple injections due to a variety of causes to include: different injection level, different initial distribution of the injectate and multiple overlapping causes of back pain.

Conclusion

A large percentage of patients treated for back pain or sciatica by LESI receive total or substantial pain relief immediately after the LESI procedure, presumably due to the infused local anesthetic. This suggests that various epidural accessible pain receptors in the spinal canal are responsible for pain in these patients. This observation may have diagnostic implications in targeting the cause of low back pain or sciatica and could be useful in predicting outcome from future injection procedures or interventional treatments.