Abstract PR302

Abstract

Background:In refractory pain, interventional procedures have been used successfully.(1) Objectives:To study and compare the efficacy of inter-laminar steroid injection and caudal epidural steroid injection in chronic radicular low back pain. Materials & Methods:After institutional ethics approval and written informed consent, a prospective, interventional assessor blinded study involving 60 patients (nmaster no.2, α error= 5%, power of study-80%). Aged 18-65years. Numeric rating scale (NRS) of radicular low back pain of 4 at rest for 12weeks in whom conservative therapy failed. Allocated either Group I (inter-laminar à conventional epidural injection in sitting position with 18G Tuohy’s needle consisting of 60mg Triamcinolone, 0.5ml of 0.5% Bupivacaine and 4ml of normal saline) or Group C (Caudalà fluoroscopy guided caudal epidural injection in prone position with 23G Quincke’s needle consisting of 80mg of Triamcinolone, 0.5ml of 0.5% Bupivacaine and 5.5ml of normal saline) by computer generated numbers. Intervention was done as a day care procedure under strict aseptic precautions and patient was discharged 2hours after observation. Cold fomentation was advised for 2 days. Analgesics in the form of Tapentadol, Paracetamol and gabapentin were continued. On day 3, they were referred to physiotherapist for back strengthening exercises. On the 1st, 3rd and 6th weeks after the procedure and they were assessed by NRS for pain, Rolland Morris low back pain and disability questionnaire, analgesic requirement and return to routine work. Results: Pain relief seen immediately after the procedure and at 1st week after the procedure were comparable in both groups but at the 3rd and 6th weeks after the procedure, Group C showed significantly better pain relief(Table 1)Table 1 -: ResultsConclusion: 1.Steroids administered by both conventional inter-laminar and fluoroscopic guided caudal techniques are effective for chronic radicular low back pain, 2.Over time, the effect of inter-laminar injection wears off while that of caudal injection stays consistent even at the 6th week, 3.Efficacy of caudal approach is better, 4.In absence of pain physician anaesthetist can treat low back pain.