Epidural Injection With or Without Steroid in Managing Chronic Low-Back and Lower Extremity Pain: A Meta-Analysis of 10 Randomized Controlled Trials

Abstract

Chronic low-back and lower extremity pain is mainly caused by lumbar disc herniation and radiculitis. Various surgery and nonsurgical modalities, including epidural injections, have been used to treat lumbar disc herniation or radiculitis. Therefore, we conducted this meta-analysis to assess the effects of the 2 interventions in managing various chronic low and lower extremity pain. A systematic literature search was conducted to identify randomized controlled trials, which compared the effect of local anesthetic with or without steroids. The outcomes included pain relief, functional improvement, opioid intake, and therapeutic procedural characteristics. Pooled estimates were calculated using a random-effects or fixed-effects model, depending on the heterogeneity between the included studies. Ten randomized controlled trials (involving 1111 patients) were included in this meta-analysis. The pooled results showed that 41.7% of patients who received local anesthetic with steroid (group 1) and 40.2% of patients who received local anesthetic alone (group 2) had significant improvement in pain relief, and the Numeric Rating Scale pain scales were significantly reduced by 4.09 scores [95% confidence interval (CI), -4.26 to -3.91] and 4.12 (95% CI, -4.35 to -3.89) scores, respectively. Similarly, 39.8% of patients in group 1 and 40.7% in group 2 achieved significantly improved functional status. The Oswestry Disability Indices in the 2 groups were reduced by 14.5 (95% CI, -15.24 to -13.75) and 12.37 (95% CI, -16.13 to -8.62), respectively. The average procedures per year in group 1 were 3.68 ± 1.17 and 3.68 ± 1.26 in group 2, with an average total relief per year of 31.67 ± 13.17 and 32.64 ± 13.92 weeks, respectively. The opioid intake decreased from baseline by 8.81 mg (95% CI, -12.24 to -5.38) and 16.92 mg (95% CI: -22.71 to -11.12) in the 2 groups, respectively. This meta-analysis confirms that epidural injections of local anesthetic with or without steroids have beneficial but similar effects in the treatment of patients with chronic low-back and lower extremity pain.

Comparison of Clinical Efficacy of Epidural Injection With or Without Steroid in Lumbosacral Disc Herniation: A Systematic Review and Meta-analysis

“…A meta-analysis (11) stated that epidural injections with only local anesthetics obtained comparable clinical benefits to those with mixture of local anesthetics and steroids. Some studies have reported that local anesthetics and steroids are equally effective in pain control and functional improvements in patients with low back pain or stenosis, and that it is not necessary to use epidural injections of steroids in such cases (10,(12)(13)(14)(15)(16).…”

The Effectiveness of Transforaminal Versus Caudal Routes for Epidural Steroid Injections in Managing Lumbosacral Radicular Pain

“…The local anesthetics are thought to have analgesic effects during the process of injection, which is beneficial for patients to relax. In these days, some researches 46 – 48 show that ESIs combined with local anesthetics get a better effect on pain relief and functional level in managing chronic low back pain. Therefore, it is necessary to add the local anesthetic during the injections.…”

Effect of Body Mass Index in Patients Administered Epidural Steroid Injection for Back Pain

“…Lumbar epidural injections can be applied as isolated local anaesthetics, local steroid applications, or combined local anaesthetic and steroid applications [13]. Although there are studies in the literature related to the efficacy of these applications, it has been reported that the combined application of local anaesthetic and steroids is superior to the application of isolated local anaesthetic [14]. In the current study, the combination of local anaesthetic and steroids was used.…”