Abstract
Transforaminal epidural injection is used to treat radicular pain. However, there is no objective method of assessing pain relief following transforaminal injection. Perfusion index is a metric for monitoring peripheral perfusion status. This study evaluates the correlation between perfusion index change and analgesic efficacy in transforaminal blocks for lumbosacral radicular pain. We retrospectively analyzed data of 100 patients receiving transforaminal block for lumbosacral radicular pain. We assessed perfusion index before treatment and at 5, 15, and 30 min following the block. We defined responders (group R) and non-responders (group N) as those with ≥50% and <50% pain reduction, respectively, 30 min following block. Clinical data and perfusion index of the groups were analyzed. Ninety-two patients were examined, of whom 57 (61.9%) and 35 (38.0%) patients reported ≥50% and <50% pain reduction, respectively. Group R had a significantly higher perfusion index change ratio 5 min following the block (p = 0.029). A perfusion index change ratio of ≥0.27 was observed in group R (sensitivity, 75.4%; specificity, 51.4%; AUC (area under the curve), 0.636; p = 0.032). A perfusion index change ratio of ≥0.27 at 5 min after block is associated with, but does not predict improvement in, pain levels following lumbosacral transforaminal block.
Highlights
Epidural injection of local anesthetics and steroids is one of the most common methods of managing chronic low back pain and radicular pain [1,2]
The Perfusion index (PI) change ratio and temperature change were presented as mean ± standard deviation (SD) (Table 2)
Lumbar ischemia can lead to several different outcomes depending on the development of collateral circulation of the lumbar feeding artery, such as vertebral bone ischemia presenting as constant dull pain and nerve root ischemia presenting as radicular pain [16]
Summary
Epidural injection of local anesthetics and steroids is one of the most common methods of managing chronic low back pain and radicular pain [1,2]. Hyaluronidase is added to the epidural injectate, which has been known to reduce tissue swelling caused by fibrin deposits and chronic inflammation [3,4]. The transforaminal approach, one of several approaches, can deliver a small volume of injectate close to the site of pathology, presumably into an inflamed nerve root, to reduce inflammation and ischemia [1,5,6,7,8]. Used screening tools and pain questionnaires include patient responses which may be affected by various factors such as comorbid conditions and/or psychosocial causes [9,10]. Perfusion index (PI) is a quantitative value of a photoplethysmography waveform that reflects real-time changes in peripheral blood flow at the site being monitored [11].
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