Transforaminal Epidural Injection of Local Anesthetic and Dorsal Root Ganglion Pulsed Radiofrequency Treatment in Lumbar Radicular Pain: A Randomized, Triple‐Blind, Active‐Control Trial

Abstract

Background Lumbar radicular pain (LRP) results from inflammation and irritation of lumbar spinal nerves and the dorsal root ganglion (DRG). Methods Our study is a prospective, triple‐blind, randomized, activecontrol trial (CTRI/2016/02/006666) comparing transforaminal epidural local anesthetic (LA) injection and pulsed radiofrequency treatment of DRG in patients with chronic LRP. Patients with LRP after failed conservative management for >3 months received selective diagnostic nerve root block with 1 mL 2% lidocaine. Fifty patients showing positive responses were divided into groups of 25 each. The LA group received transforaminal epidural injection of 1 mL 0.5% bupivacaine. The lumbar pulsed radiofrequency (LPRF) group received transforaminal epidural injection of 1 mL 0.5% bupivacaine with 3 cycles of pulsed radiofrequency of the DRG for 180 seconds Results Both groups were compared by observing pain intensity on a 0‐ to 100‐point VAS and improvement in functional status by the Oswestry Disability Index (ODI version 2.0) at 2 weeks and 1, 2, 3, and 6 months. All baseline variables were comparable between the 2 groups. Statistically significant reduction in both outcomes was seen in the LPRF group compared to the LA group from 2 weeks to 6 months. One hundred percent of patients in the LPRF group had a ≥20‐ point decrease in VAS and significant percentage reduction in ODI at all time intervals up to 6 months, whereas it was seen in 80% and 28% of patients in the LA group at 3 and 6 months, respectively. No complications were seen in any patients Conclusion Pulsed radiofrequency of the DRG applied for longer duration results in long‐term pain relief and improvement in the functional quality of life in patients with chronic LRP.

The Effect of Pulsed Radiofrequency on Radicular Pain in Lumbal Herniated Nucleus Pulposus: A Systematic Review and Meta-analysis

“…Mohan et al ( 11 ) compared the effects of PRF and TFESI on lumbosacral radicular pain. A total of 50 samples were randomly allocated to a PRF group (n = 25) and a control group (n = 25).…”

“…Khalifa and Saadalla ( 10 ) and Shanthanna et al ( 9 ) showed that the randomization technique was carried out by the sealed envelope method. Koh et al ( 8 ) and Mohan et al ( 11 ) used computer-based randomization and were categorized as low-risk bias. Meanwhile, other studies did not mention the randomization method and were assessed as unclear risk of bias.…”

Comparison of Pulsed Radiofrequency, Oxygen-Ozone Therapy and Epidural Steroid Injections for the Treatment of Chronic Unilateral Radicular Syndrome

“…PRF treatment is increasingly being used in the management of chronic pain syndromes [12,20]. The use of PRF in the DRG of the cervical radicular spine is promising.…”

Predictors of the Analgesic Efficacy of CT‐Guided Percutaneous Pulsed Radiofrequency Treatment of Gasserian Ganglion in Patients With Idiopathic Trigeminal Neuralgia

“…18 Pulsed radiofrequency (PRF) is a minimally destructive percutaneous interventional treatment for several chronic pain syndromes. [19][20][21] Although PRF has few postoperative adverse reactions, its analgesic efficacy is not always guaranteed. Unlike radiofrequency thermocoagulation, the temperature of PRF treatment remains below 42°C since the heat generated during treatment (20 milliseconds) could dissipate during the interval between pulses (480 milliseconds).…”

“…Pulsed radiofrequency (PRF) is a minimally destructive percutaneous interventional treatment for several chronic pain syndromes 19–21 . Although PRF has few postoperative adverse reactions, its analgesic efficacy is not always guaranteed.…”