Comparison Immediate and Acute Adverse Effects Following Transforaminal Epidural Steroid Injections with Dexamethasone and Diluted Triamcinolone
Abstract
Background: Transforaminal epidural steroid injections (both lumbar and cervical) are used in many treatments. The use of this method in the control and treatment of radicular pain is intensively expanding. In this method, and for the purpose of implementing the injection process, the needle is inserted from the posterolateral of the spine and steroids injected.
Steroids include a wide range of medications, many of which are used in modern medicine. Research on these drugs is still underway. The use of Dexamethasone in lumbar transforaminal epidural injections and the study of complications caused by it have been less studied. In some previous studies, use of this steroid for lumbar transforaminal epidural injections has been mentioned.
Methods: The present study was conducted in Shohada-e-Tajrish Hospital in Tehran. Patients over 18 years of age who were afflicted with Lumbar stenosis Foraminal (Diagnosis by MRI) and had associated with Radio Kevlar pain were selected. These patients are divided into two groups of 14. In a group, 2.5 cc dexamethasone 8 mg / cc diluted with 2.5 cc distilled water was injected. In the second group, 2.5 cc triamcinolone 40 mg / cc was injected with 2.5 cc distilled water in a volume of 5 cc. In order to evaluate and compare the effects of these two steroids on the patients, the results of the questionnaire were evaluated by statistical techniques and software SPSS 21.
Results: The results showed that the use of dexamethasone had far more successful effects than another drug. However, the above conclusion is a relative conclusion and absolute expression is not possible. Pharmaceutical manifestations are the result of patient reactions. Thus, doing similar research and comparing drug performance should be put on the agenda of various research and medical teams.
Conclusion: Use of Dexamethasone had far more successful effects than Triamcinolone on epidural steroid injections.
2. Cooper G, Lutz GE, Boachie-Adjei O, Lin J. Effectiveness of transforaminal epidural steroid injections in patients with degenerative lumbar scoliotic stenosis and radiculopathy. Pain Physician. 2004; 7(3):311-8.
3. Vad VB, Bhat AL, Lutz GE, Cammisa F. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine. 2002; 27(1):11-5.
4. Buenaventura RM, Datta S, Abdi S, Smith HS. Systematic review of therapeutic lumbar transforaminal epidural steroid injections. Pain Physician. 2009; 12(1):233-51.
5. Schaufele MK, Hatch L, Jones W. Interlaminar versus transforaminal epidural injections for the treatment of symptomatic lumbar intervertebral disc herniations. Pain Physician. 2006; 9(4):361.
6. Lutz GE, Vad VB, Wisneski RJ. Fluoroscopic transforaminal lumbar epidural steroids: an outcome study. Arch Phys Med Rehabil. 1998; 79(11):1362-6.
7. Young IA, Hyman GS, Packia-Raj LN, Cole AJ. The use of lumbar epidural/transforaminal steroids for managing spinal disease. J Am Acad Orthop Surg. 2007; 15(4):228-38.
8. Ackerman WE, Ahmad M. The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Anesth Analg. 2007; 104(5):1217-22.
9. Baker R, Dreyfuss P, Mercer S, Bogduk N. Cervical transforaminal injection of corticosteroids into a radicular artery: a possible mechanism for spinal cord injury. Pain. 2003; 103(1-2):211-5.
10. Muro K, O'shaughnessy B, Ganju A. Infarction of the cervical spinal cord following multilevel transforaminal epidural steroid injection: case report and review of the literature. J Spinal Cord Med. 2007; 30(4):385-8.
11. Tiso RL, Cutler T, Catania JA, Whalen K. Adverse central nervous system sequelae after selective transforaminal block: the role of corticosteroids. Spine J. 2004; 4(4):468-74.
12. Rozin L, Rozin R, Koehler SA, Shakir A, Ladham S, Barmada M, et al. Death during transforaminal epidural steroid nerve root block (C7) due to perforation of the left vertebral artery. Am J Forensic Med Pathol. 2003 Dec 1;24(4):351-5.
13. Houten JK, Errico TJ. Paraplegia after lumbosacral nerve root block: report of three cases. Spine J. 2002 Jan; 2(1):70-5.
14. Rathmell JP, Aprill C, Bogduk N. Cervical transforaminal injection of steroids. Anesthesiology. 2004; 100(6):1595-600.
15. Okubadejo GO, Talcott MR, Schmidt RE, Sharma A, Patel AA, Mackey RB, et al. Perils of intravascular methylprednisolone injection into the vertebral artery: an animal study. J Bone Joint Surg Am. 2008; 90(9):1932-8.
16. Benzon HT, Chew TL, McCarthy RJ, Benzon HA, Walega DR. Comparison of the Particle Sizes of Different Steroids and the Effect of DilutionA Review of the Relative Neurotoxicities of the Steroids. Anesthesiology. 2007; 106(2):331-8.
17. El Abd O, Amadera J, Pimentel DC, Gomba L. Immediate and acute adverse effects following transforaminal epidural steroid injections with dexamethasone. Pain Physician. 2015; 18(3):277-86.
18. Kim DW, Han KR, Kim C, Chae YJ. Intravascular flow patterns in transforaminal epidural injections: a comparative study of the cervical and lumbar vertebral segments. Anesth Analg. 2009;109(1):233-9.
19. Hosseini B, Ataei MH, Momenzadeh S, Ommi D. The comparsion between steroid and hypertonic saline 10% with steroid in transforaminal epidural injection in patients with unilateral foraminal stenosis. International Clinical Neuroscience Journal. 2015; 2(2):50-4.
20. Scanlon GC, Moeller-Bertram T, Romanowsky SM, Wallace MS. Cervical transforaminal epidural steroid injections: more dangerous than we think? Spine. 2007; 32(11):1249-56.
21. Helm Ii S, Benyamin RM, Chopra P, Deer TR, Justiz R. Percutaneous adhesiolysis in the management of chronic low back pain in post lumbar surgery syndrome and spinal stenosis: a systematic review. Pain Physician. 2012; 15(4): E435-62.
22. Piaggio G, Elbourne DR, Pocock SJ, Evans SJ, Altman DG, CONSORT Group FT. Reporting of noninferiority and equivalence randomized trials: extension of the CONSORT 2010 statement. Jama. 2012; 308(24):2594-604.
23. Tuba Z, Mahó S, Sánta C. Corticosteroids: From Natural Products to Useful Analogues. Analogue‐based Drug Discovery. 2006:419-40.
24. El Abd O, Amadera JE, Pimentel DC. Poster 354 General Pruritus as an Unusual Adverse Effect After Transforaminal Epidural Injection with Dexamethasone: A Case Report. PM&R. 2011; 3(10): S296.
25. Baharav E, Harpaz D, Mittelman M, Lewinski UH. Dexamethasone-induced perineal irritation. N Engl J Med. 1986; 314(8):515-6.
26. Vinson GP. The mislabelling of deoxycorticosterone: making sense of corticosteroid structure and function. Journal of Endocrinology. 2011; 211(1):3-16.
27. Hashemi M, Dadkhah P, Taheri M, Ghasemi M. Effects of Caudal Epidural Dexmedetomidine on Pain, Erythrocyte Sedimentation Rate and Quality of Life in Patients with Failed Back Surgery Syndrome; A Randomized Clinical Trial. Bull Emerg Trauma. 2019; 7(3): 245–250.
Files | ||
Issue | Vol 5 No 4 (2019): Autumn | |
Section | Research Article(s) | |
DOI | https://doi.org/10.18502/aacc.v5i4.1451 | |
Keywords | ||
Transforaminal Epidural Steroid Dexamethasone Triamcinolone |
Rights and permissions | |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |