Lumbosacral radicular pain is a condition where pain originating in the lower back radiates down through the hips, buttocks and legs. While lumbosacral radicular pain primarily affects an individual’s physical wellbeing, it can also have important social and economic implications. Additionally, the prevalence of lumbosacral pain is increasing worldwide. The epidural injections are an alternative approach to treat lumbosacral radicular pain instead of surgical therapy. Epidural steroid injections are often combined with local anesthetic and injected to reduce pain associated with conditions that cause inflammation and pain in the spine. It’s worth noting that while epidural steroid injections can provide significant pain relief for many people, they are associated with potential risks and side effects. Epidural steroid injections can occasionaly lead to allergic reactions in some individuals. If it is not possible to administer steroids in the epidural space due to patient’s allergy, then we can administer only local anesthetic. Case report: A 70 years old woman came to our clinic complaining with acute pain in her left lumbar back and left leg related to her L5-S1 radiculopathy. The patient reported skin rash and angioedema after a previous epidural with only triamcinolone. Method: After signing the consent form, in a aseptic technique, the patient receives only the local anesthetic (bupivacaine 5 mg and ropivacaine 4 mg diluted with physiological solution for a total volume of 6 ml) in the lumbar epidural space at L4-L5 via interlaminar approach. Clinical evaluation was performed before the procedure, immediately after the injection and at one, three and six months after injection using Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI). Results: The patient reports an immediate pain reduction (NRS 10 before local anesthetic injection, NRS 4 immediately after the injection). Still after three months post injection, the patient reports a reduction of pain intensity (NRS 3) with 30 % ODI index. Conclusion: Epidural steroid injections have been widely used for over 50 years in the treatment of low-back pain with radiculopathy but many doctors do not believe in the efficacy of corticosteroids administered in the epidural space. Recent reviews have disclosed controversial results and have questioned the effectiveness of epidural steroid injections. Injecting only local anesthetic in the epidural space eliminates the side effects associated with corticosteroids; therefore, it is possible to repeat injection more frequently. Further studies are needed to evaluate the true role of local anesthetic in the epidural level.
| Published in | American Journal of Life Sciences (Volume 11, Issue 4) |
| DOI | 10.11648/j.ajls.20231104.13 |
| Page(s) | 64-71 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2024. Published by Science Publishing Group |
Steroid, Local Anesthetic, Epidural Injection
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APA Style
Federica Giulietti, Catello Pellegrino, Alessandra Parini, Cristina Scala. (2023). Epidural Injection with Only Local Anesthetic for Lumbosacral Radicular Pain: A Case Report. American Journal of Life Sciences, 11(4), 64-71. https://doi.org/10.11648/j.ajls.20231104.13
ACS Style
Federica Giulietti; Catello Pellegrino; Alessandra Parini; Cristina Scala. Epidural Injection with Only Local Anesthetic for Lumbosacral Radicular Pain: A Case Report. Am. J. Life Sci. 2023, 11(4), 64-71. doi: 10.11648/j.ajls.20231104.13
AMA Style
Federica Giulietti, Catello Pellegrino, Alessandra Parini, Cristina Scala. Epidural Injection with Only Local Anesthetic for Lumbosacral Radicular Pain: A Case Report. Am J Life Sci. 2023;11(4):64-71. doi: 10.11648/j.ajls.20231104.13
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Download@article{10.11648/j.ajls.20231104.13,
author = {Federica Giulietti and Catello Pellegrino and Alessandra Parini and Cristina Scala},
title = {Epidural Injection with Only Local Anesthetic for Lumbosacral Radicular Pain: A Case Report},
journal = {American Journal of Life Sciences},
volume = {11},
number = {4},
pages = {64-71},
doi = {10.11648/j.ajls.20231104.13},
url = {https://doi.org/10.11648/j.ajls.20231104.13},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajls.20231104.13},
abstract = {Lumbosacral radicular pain is a condition where pain originating in the lower back radiates down through the hips, buttocks and legs. While lumbosacral radicular pain primarily affects an individual’s physical wellbeing, it can also have important social and economic implications. Additionally, the prevalence of lumbosacral pain is increasing worldwide. The epidural injections are an alternative approach to treat lumbosacral radicular pain instead of surgical therapy. Epidural steroid injections are often combined with local anesthetic and injected to reduce pain associated with conditions that cause inflammation and pain in the spine. It’s worth noting that while epidural steroid injections can provide significant pain relief for many people, they are associated with potential risks and side effects. Epidural steroid injections can occasionaly lead to allergic reactions in some individuals. If it is not possible to administer steroids in the epidural space due to patient’s allergy, then we can administer only local anesthetic. Case report: A 70 years old woman came to our clinic complaining with acute pain in her left lumbar back and left leg related to her L5-S1 radiculopathy. The patient reported skin rash and angioedema after a previous epidural with only triamcinolone. Method: After signing the consent form, in a aseptic technique, the patient receives only the local anesthetic (bupivacaine 5 mg and ropivacaine 4 mg diluted with physiological solution for a total volume of 6 ml) in the lumbar epidural space at L4-L5 via interlaminar approach. Clinical evaluation was performed before the procedure, immediately after the injection and at one, three and six months after injection using Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI). Results: The patient reports an immediate pain reduction (NRS 10 before local anesthetic injection, NRS 4 immediately after the injection). Still after three months post injection, the patient reports a reduction of pain intensity (NRS 3) with 30 % ODI index. Conclusion: Epidural steroid injections have been widely used for over 50 years in the treatment of low-back pain with radiculopathy but many doctors do not believe in the efficacy of corticosteroids administered in the epidural space. Recent reviews have disclosed controversial results and have questioned the effectiveness of epidural steroid injections. Injecting only local anesthetic in the epidural space eliminates the side effects associated with corticosteroids; therefore, it is possible to repeat injection more frequently. Further studies are needed to evaluate the true role of local anesthetic in the epidural level.},
year = {2023}
}
TY - JOUR T1 - Epidural Injection with Only Local Anesthetic for Lumbosacral Radicular Pain: A Case Report AU - Federica Giulietti AU - Catello Pellegrino AU - Alessandra Parini AU - Cristina Scala Y1 - 2023/08/31 PY - 2023 N1 - https://doi.org/10.11648/j.ajls.20231104.13 DO - 10.11648/j.ajls.20231104.13 T2 - American Journal of Life Sciences JF - American Journal of Life Sciences JO - American Journal of Life Sciences SP - 64 EP - 71 PB - Science Publishing Group SN - 2328-5737 UR - https://doi.org/10.11648/j.ajls.20231104.13 AB - Lumbosacral radicular pain is a condition where pain originating in the lower back radiates down through the hips, buttocks and legs. While lumbosacral radicular pain primarily affects an individual’s physical wellbeing, it can also have important social and economic implications. Additionally, the prevalence of lumbosacral pain is increasing worldwide. The epidural injections are an alternative approach to treat lumbosacral radicular pain instead of surgical therapy. Epidural steroid injections are often combined with local anesthetic and injected to reduce pain associated with conditions that cause inflammation and pain in the spine. It’s worth noting that while epidural steroid injections can provide significant pain relief for many people, they are associated with potential risks and side effects. Epidural steroid injections can occasionaly lead to allergic reactions in some individuals. If it is not possible to administer steroids in the epidural space due to patient’s allergy, then we can administer only local anesthetic. Case report: A 70 years old woman came to our clinic complaining with acute pain in her left lumbar back and left leg related to her L5-S1 radiculopathy. The patient reported skin rash and angioedema after a previous epidural with only triamcinolone. Method: After signing the consent form, in a aseptic technique, the patient receives only the local anesthetic (bupivacaine 5 mg and ropivacaine 4 mg diluted with physiological solution for a total volume of 6 ml) in the lumbar epidural space at L4-L5 via interlaminar approach. Clinical evaluation was performed before the procedure, immediately after the injection and at one, three and six months after injection using Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI). Results: The patient reports an immediate pain reduction (NRS 10 before local anesthetic injection, NRS 4 immediately after the injection). Still after three months post injection, the patient reports a reduction of pain intensity (NRS 3) with 30 % ODI index. Conclusion: Epidural steroid injections have been widely used for over 50 years in the treatment of low-back pain with radiculopathy but many doctors do not believe in the efficacy of corticosteroids administered in the epidural space. Recent reviews have disclosed controversial results and have questioned the effectiveness of epidural steroid injections. Injecting only local anesthetic in the epidural space eliminates the side effects associated with corticosteroids; therefore, it is possible to repeat injection more frequently. Further studies are needed to evaluate the true role of local anesthetic in the epidural level. VL - 11 IS - 4 ER -
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