Cody R Quirk1, Anthony Onofrio2, James T Patrie3, Nicholas C Nacey4. 1. Department of Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, Charleston, SC, 29425, USA. 2. United Imaging Consultants, LLC, 5800 Foxridge Dr, Suite 240, Mission, KS, 66202, USA. 3. Public Health Sciences, University of Virginia School of Medicine, Old Med School 3883, PO Box 800717, Charlottesville, VA, 22903, USA. 4. Department of Radiology and Medical Imaging, University of Virginia School of Medicine, 1215 Lee St, PO Box 800170, Charlottesville, VA, 22903, USA. ncn5t@hscmail.mcc.virginia.edu.
Abstract
OBJECTIVE: A local anesthetic is frequently administered as part of a lumbar epidural steroid injection (LESI); however, there is a rare potential for this to result in transient paralysis if administered incorrectly. The purpose of this retrospective study is to determine if the addition of bupivacaine significantly improves patient-reported pain scores. MATERIALS AND METHODS: This retrospective review includes patients undergoing LESI over an approximately 1 year time span. Pre-procedure, immediate post-procedure, and 1-week integer scaled pain scores were recorded. Ordinal regression was used to compare the distributions of the aggregated ordinal pain score categories between bupivacaine- and non-bupivacaine-injected patients. RESULTS: Two hundred fifty-eight patients met the inclusion criteria (126F:132 M, mean age 64.7 years) with 164 receiving bupivacaine and steroids and 94 receiving steroids alone. The relative frequency distributions for pre-injection pain did not differ between the bupivacaine patients and the non-bupivacaine patients (p = 0.114). Similarly, the relative frequency distributions for immediate and 1-week post-procedure pain did not differ between the bupivacaine patients and the non-bupivacaine patients (p = 0.293 at immediate time point and p = 0.306 at 1-week time point). Odds ratios comparing pain severity change between the bupivacaine and non-bupivacaine patients also were not significantly different at either the immediate post-procedure (p = 0.769) or 1-week (p = 0.203) time points. CONCLUSION: The lack of a significant downward shift in the bupivacaine patients' post-procedure pain scores compared to the non-bupivacaine patients' post-procedure pain scores raises doubts about bupivacaine's utility as a standard component of a lumbar epidural injection.
OBJECTIVE: A local anesthetic is frequently administered as part of a lumbar epidural steroid injection (LESI); however, there is a rare potential for this to result in transient paralysis if administered incorrectly. The purpose of this retrospective study is to determine if the addition of bupivacaine significantly improves patient-reported pain scores. MATERIALS AND METHODS: This retrospective review includes patients undergoing LESI over an approximately 1 year time span. Pre-procedure, immediate post-procedure, and 1-week integer scaled pain scores were recorded. Ordinal regression was used to compare the distributions of the aggregated ordinal pain score categories between bupivacaine- and non-bupivacaine-injected patients. RESULTS: Two hundred fifty-eight patients met the inclusion criteria (126F:132 M, mean age 64.7 years) with 164 receiving bupivacaine and steroids and 94 receiving steroids alone. The relative frequency distributions for pre-injection pain did not differ between the bupivacainepatients and the non-bupivacainepatients (p = 0.114). Similarly, the relative frequency distributions for immediate and 1-week post-procedure pain did not differ between the bupivacainepatients and the non-bupivacainepatients (p = 0.293 at immediate time point and p = 0.306 at 1-week time point). Odds ratios comparing pain severity change between the bupivacaine and non-bupivacainepatients also were not significantly different at either the immediate post-procedure (p = 0.769) or 1-week (p = 0.203) time points. CONCLUSION: The lack of a significant downward shift in the bupivacainepatients' post-procedure pain scores compared to the non-bupivacainepatients' post-procedure pain scores raises doubts about bupivacaine's utility as a standard component of a lumbar epidural injection.
Authors: Laxmaiah Manchikanti; Nebojsa Nick Knezevic; Jaya Sanapati; Alan D Kaye; Mahendra R Sanapati; Joshua A Hirsch Journal: Pain Physician Date: 2021-01 Impact factor: 4.965