Epidural Steroid Injection in Korean Pain Physicians: A National Survey

Abstract

BackgroundEpidural steroid injection (ESI) is one of the most common procedures for patients presenting low back pain and radiculopathy. However, there is no clear consensus on what constitutes appropriate steroid use for ESIs. To investigate optimal steroid injection methods for ESIs, surveys were sent to all academic pain centers and selected private practices in Korea via e-mail.MethodsAmong 173 pain centers which requested the public health insurance reimbursements for their ESIs and were enrolled in the Korean Pain Society, 122 completed questionnaires were returned, for a rate of 70.5%; also returned were surveys from 39 academic programs and 85 private practices with response rates of 83.0% and 65.9%, respectively.ResultsMore than half (55%) of Korean pain physicians used dexamethasone for ESIs. The minimum interval of subsequent ESIs at the academic institutions (3.1 weeks) and the private practices (2.1 weeks) were statistically different (P = 0.01).ConclusionsAlthough there was a wide range of variation, there were no significant differences between the academic institutions and the private practices in terms of the types and single doses of steroids for ESIs, the annual dose of steroids, or the limitations of doses in the event of diabetes, with the exception of the minimum interval before the subsequent ESI.

The effect of epidurally administered dexamethasone with lignocaine for post-operative analgesia in dogs undergoing ovariohysterectomy. A dose-response study

“…In humans, lumbar epidural dexamethasone has been used to treat patients with postoperative pain resulting from lower abdominal surgeries 10,17 , hysterectomy 11 or orchiopexy and back pain 1,18,19 . The authors are unaware of any studies on the use of epidural dexamethasone in dogs to relieve pain and increase the duration of action of the lignocaine local anaesthetic in the postoperative period.…”

Analgesia after Epidural Dexamethasone is Further Enhanced by IV Dipyrone, but Not IV Parecoxibe Following Minor Orthopedic Surgery

“…The reason for the epidural route of dexamethasone administration instead of the IV was based in its historically positive effect in orthopedics [ 4 , 5 , 6 , 7 , 8 ]. It may be acting at spinal sites by inducing the synthesis of the phospholipase-A2 inhibitory protein lipocortin [ 9 ].…”

“…Indeed, fifty years have elapsed since the first publication of epidural dexamethasone for pain relief [ 8 ], and it has been used for orthopedics [ 4 , 5 , 6 , 7 ], for other surgicals [ 15 , 16 , 17 , 18 ] or pain [ 8 , 19 ] procedures. The non-particulate dexamethasone is the routine steroid used in our Pain Center for the past 25 years.…”

“…These characteristics transform this drug as one of the safest for epidural administration [ 21 ]. The epidural dexamethasone dose varied in the literature from 0.1 mg/kg in children 15 to 10 mg in adults [ 6 , 19 ]. In our study, the decision for the association of epidural dexamethasone to spinal bupivacaine was based on previous positive effects in different postoperative types of pain [ 4 , 5 , 6 , 7 , 15 , 16 , 17 , 18 ].…”

“…Therefore, it is commanding that the patient can get home in the same day with efficient analgesia along with no adverse effects, and non-opioid drugs combinations represent a good alternative for safety. Because epidural dexamethasone has been previously demonstrated to be competent after orthopedic surgeries [ 3 , 4 , 5 ] or back pain [ 6 ], we evaluated different intravenous (IV) non-narcotic analgesics combined to epidural dexamethasone under spinal bupivacaine anesthesia in patients scheduled to minor orthopedic surgeries.…”