Comparison of retrolaminar paravertebral infiltration of a non - steroid mixture with conventional epidural steroid infiltration in patients suffering from chronic radicular Pain- a retrospective study

Background: Chronic radicular pain is often treated by epidural steroidinfiltration (ESI). In 2014, the Food and Drug Administration (FDA) issued aletter warning that ESI may result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death . In this retrospective study, wecompare retrolaminar paravertebral infiltration (PVI) of a non-steroid-mixturewith an epidural steroid injection (ESI).Materials and Methods: We identified 31 patients registered in the QuebecPain Registry suffering from chronic lumbar or cervical radicular painreferred to the Centre Hospitalier de l’Université de Montréal (CHUM) painclinic between 2009 to 2014. These patients received ultrasound-guidedretrolaminar PVI with a mixture of morphine 1 mg, ketamine 10 mg,neostigmine 0.5 mg, naloxone 2ng, and bupivacaine 10 mg. The controlgroup, matched for gender, age, and DN4 sub-scale score at baseline,consisted of 31 patients with the same pathology; they were treated byfluoroscopic-guided ESI. Principal pathologies in both groups were discdisorders and/or foraminal stenosis. All patients received only one infiltrationduring the six months following the initial visit. The numerical rating sc ale(NRS-11) was assessed at the first visit and six months later. The BPI, PCSand SF-12 were compared in both groups. Overall satisfaction with pain reliefafter six months was assessed with a scale of 1 (very unsatisfied) to 6 (verysatisfied).Results: Average NRS-11 scores for the seven days preceding the first visitand after six months were compared in both groups. The same comparisonwas made for overal1 treatment satisfaction. There is no significantdifference in the NRS-11 and in the satisfaction scores between the twogroups.Conclusion: Neither of the two methods was shown to be superior to theother in pain relief and overall treatment satisfaction after six months.Considering the possible complications and side effects of ESI, PVI with anon-steroid mixture might be considered as an alternative method. Possibly,multiple PVIs could further decrease pain. Well-designed studies are neededto evaluate this hypothesis.

کلیدواژه ها:

Retrolaminar Paravertebral ، Chronic Pain ، Epidural Steroid ، Morphine ، Neostigmine ، Ketamine ، Naloxone