A Comparison Between Epidural Anaesthesia and Bed Rest in Sciatica

Coomes, E. N.

doi:10.1136/bmj.1.5218.20

Cited by 62 publications

(7 citation statements)

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“…For patients with sciatica, trials have compared other therapies with bed rest (an example is Coomes's 1961 comparison of epidural anesthesia with bed rest 18 ), but the effectiveness of bed rest itself in patients with sciatica has been unclear. Although we found no adverse effects of bed rest, numerous adverse effects, both physical [19][20][21][22][23][24][25][26][27] and psychological, 28,29 have been reported.…”

Section: T Able 3 S Econdary O Utcomes Among the P Atients In The B mentioning

confidence: 99%

Lack of Effectiveness of Bed Rest for Sciatica

Vroomen¹,

Krom²,

Wilmink³

et al. 1999

N Engl J Med

203

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Section: T Able 3 S Econdary O Utcomes Among the P Atients In The B mentioning

confidence: 99%

Lack of Effectiveness of Bed Rest for Sciatica

Vroomen¹,

Krom²,

Wilmink³

et al. 1999

N Engl J Med

203

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“…[ 3 6 19 66 67 99 148 155 158 167 168 181 191 ] The first reports of caudal epidural injections were with local anesthetics alone. [ 20 32 40 169 185 ] Evans[ 40 ] and Cyriax[ 32 ] published multiple manuscripts indicating the effectiveness of local anesthetic injections without steroid. Bicket et al .…”

Section: Introductionmentioning

confidence: 99%

Comparison of the efficacy of saline, local anesthetics, and steroids in epidural and facet joint injections for the management of spinal pain: A systematic review of randomized controlled trials

Manchikanti¹,

De²,

Kn³

et al. 2015

Surg Neurol Int

100

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Background:The efficacy of epidural and facet joint injections has been assessed utilizing multiple solutions including saline, local anesthetic, steroids, and others. The responses to these various solutions have been variable and have not been systematically assessed with long-term follow-ups.Methods:Randomized trials utilizing a true active control design were included. The primary outcome measure was pain relief and the secondary outcome measure was functional improvement. The quality of each individual article was assessed by Cochrane review criteria, as well as the criteria developed by the American Society of Interventional Pain Physicians (ASIPP) for assessing interventional techniques. An evidence analysis was conducted based on the qualitative level of evidence (Level I to IV).Results:A total of 31 trials met the inclusion criteria. There was Level I evidence that local anesthetic with steroids was effective in managing chronic spinal pain based on multiple high-quality randomized controlled trials. The evidence also showed that local anesthetic with steroids and local anesthetic alone were equally effective except in disc herniation, where the superiority of local anesthetic with steroids was demonstrated over local anesthetic alone.Conclusion:This systematic review showed equal efficacy for local anesthetic with steroids and local anesthetic alone in multiple spinal conditions except for disc herniation where the superiority of local anesthetic with steroids was seen over local anesthetic alone.

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“…Fibrous tissue may entrap the nerve root creating pain on movement [59]. Use of epidural steroid injections has been shown to shorten the period of illness for patients [60]. It has also been shown to decrease the frequency and intensity of the pain in 66% of patients [61].…”

Section: Epidural Steroid Injectionmentioning

confidence: 98%