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80: The Use of Lumbar Epidural Steroid Injections in Lumbar Spinal Stenosis (LSS)
Posters
80. The use of lumbar epidural steroid injections in lumbar spinal stenosis (LSS) J. Geelen, C. Vandenbosch, M. Puylaert, P. Vanelderen, P. De Vooght, L. Van Keer, R. Heylen, J. Van Zundert Ziekenhuis Oost-Limburg, Anesthesiology, Genk, Belgium Introduction: Lumbar Spinal Stenosis (LSS), narrowing of the central spinal canal, can cause irradiating pain in the lower extremities. There is no consensus whether lumbar epidural steroid injections are an effective treatment for symptomatic LSS (1). Methods and Materials: We reviewed the outcome of epidural injection of 40 mg methylprednisoloneacetate and lidocaine 2 % with adrenaline 1/80000 2 ml in 42 patients with symptomatic LSS. Based on imaging (CT or MRI) LSS was classified as moderate or severe, with or without other possible causes for irradiating pain (eg. Dischernia / foraminal stenosis) according to criteria by J. Van Goethem et al (2). All patients received minimum 2 infiltrations with 3 weeks interval. A third infiltration was optional if pain was persisting.
Results:
Group 2 Moderate LSS with other possible causes
Group 3 Severe LSS
7
12
10
13
6,8
7,9
8,1
8,4
4,6
4,2
5,0
4,9
2,2
3,7
3,1
3,5
Group 1 Moderate LSS Number of patients VAS Before VAS after 1 month VAS reduction
Chronic Pain Management
193
108. National survey of current practice of IVRSB for CRPS and a local audit examining the effectiveness of bretylium S. Shenoy1, A. Sharma2, S. Vashisht2, B. Vadodaria2 1Royal Brompton Hospital, London, UK, 2Hillingdon Hospital, Uxbridge, UK Background and Aims: Various techniques and drugs have been used in treating pain associated with CRPS. We conducted a nationwide survey of current practice and incidence of complications of intravenous regional sympathetic block (IVRSB). Evidence suggests that Bretylium is better than Guanethidine. Coincidently, since we routinely use Bretylium we decided to audit the efficacy of IVRSB with Bretylium. Methods: 1. A postal questionnaire was sent to all the Chronic Pain departments in UK to examine several aspects of current practice regarding the use of IVRSB. 2. IVRSB with Bretylium: We reviewed the files of 30 patients who had the procedure and noted diagnosis, drugs and adjuncts and complications. Then, a questionnaire was sent to these patients to assess pain relief and adverse effects.
Follow up was done 1 month after the last infiltration.
Group 4 Severe LSS with other possible causes
•
Results:
Total
42
Conclusions: These data suggest that lumbar epidural steroid injections can have a beneficial short-term effect for symptomatic LSS in the 4 subgroups. These results justify further (and larger) controlled trials. References (1) Fukusaki M et al Symptons of spinal stenosis do not improve after epidural steroid injection Clin J Pain, 1998 Jun; 14(2) : 148-51. (2) Van Goethem J et al Spinal Imaging; Springer-verlag Berlin Heidelberg 2007; Ch. 8 : 185-209.
1. Survey: We received 54% completed questionnaires. 76.7% performed IVRSB. There is wide variation in technique and therapeutic regimes across UK. Guanethidine was the commonly used agent with bretylium being used only in 6 centres. Many clinicians who used Guanethidine preferred to use Bretylium but believed it was not available in UK. Most patients were treated weekly. 2. Audit: Bretylium with Prilocaine (90%) or lidocaine (10%) was used. Ninety three percent patients received ketorolac as an adjunct. One received magnesium sulphate. IVRSB showed excellent pain relief in 12%, good pain relief in 12%, and some pain relief in 16%. IVRSB improved limb circulation in 36% and reduction in analgesic requirement in 67% of patients. Conclusion: 1. IVRSB is extensively practiced in UK as an adjunct to pharmacotherapy. It may provide relief of neuropathic pain in some cases. However, evidence of significant benefit is currently lacking. 2. IVRSB with Bretylium and Ketorolac is a low risk and a reasonable option in patients with CRPS. Large studies are required to assess the efficacy and make any guidelines.
80. The use of lumbar epidural steroid injections in lumbar spinal stenosis (LSS) J. Geelen, C. Vandenbosch, M. Puylaert, P. Vanelderen, P. De Vooght, L. Van Keer, R. Heylen, J. Van Zundert Ziekenhuis Oost-Limburg, Anesthesiology, Genk, Belgium Introduction: Lumbar Spinal Stenosis (LSS), narrowing of the central spinal canal, can cause irradiating pain in the lower extremities. There is no consensus whether lumbar epidural steroid injections are an effective treatment for symptomatic LSS (1). Methods and Materials: We reviewed the outcome of epidural injection of 40 mg methylprednisoloneacetate and lidocaine 2 % with adrenaline 1/80000 2 ml in 42 patients with symptomatic LSS. Based on imaging (CT or MRI) LSS was classified as moderate or severe, with or without other possible causes for irradiating pain (eg. Dischernia / foraminal stenosis) according to criteria by J. Van Goethem et al (2). All patients received minimum 2 infiltrations with 3 weeks interval. A third infiltration was optional if pain was persisting.
Results:
Group 2 Moderate LSS with other possible causes
Group 3 Severe LSS
7
12
10
13
6,8
7,9
8,1
8,4
4,6
4,2
5,0
4,9
2,2
3,7
3,1
3,5
Group 1 Moderate LSS Number of patients VAS Before VAS after 1 month VAS reduction
Chronic Pain Management
193
108. National survey of current practice of IVRSB for CRPS and a local audit examining the effectiveness of bretylium S. Shenoy1, A. Sharma2, S. Vashisht2, B. Vadodaria2 1Royal Brompton Hospital, London, UK, 2Hillingdon Hospital, Uxbridge, UK Background and Aims: Various techniques and drugs have been used in treating pain associated with CRPS. We conducted a nationwide survey of current practice and incidence of complications of intravenous regional sympathetic block (IVRSB). Evidence suggests that Bretylium is better than Guanethidine. Coincidently, since we routinely use Bretylium we decided to audit the efficacy of IVRSB with Bretylium. Methods: 1. A postal questionnaire was sent to all the Chronic Pain departments in UK to examine several aspects of current practice regarding the use of IVRSB. 2. IVRSB with Bretylium: We reviewed the files of 30 patients who had the procedure and noted diagnosis, drugs and adjuncts and complications. Then, a questionnaire was sent to these patients to assess pain relief and adverse effects.
Follow up was done 1 month after the last infiltration.
Group 4 Severe LSS with other possible causes
•
Results:
Total
42
Conclusions: These data suggest that lumbar epidural steroid injections can have a beneficial short-term effect for symptomatic LSS in the 4 subgroups. These results justify further (and larger) controlled trials. References (1) Fukusaki M et al Symptons of spinal stenosis do not improve after epidural steroid injection Clin J Pain, 1998 Jun; 14(2) : 148-51. (2) Van Goethem J et al Spinal Imaging; Springer-verlag Berlin Heidelberg 2007; Ch. 8 : 185-209.
1. Survey: We received 54% completed questionnaires. 76.7% performed IVRSB. There is wide variation in technique and therapeutic regimes across UK. Guanethidine was the commonly used agent with bretylium being used only in 6 centres. Many clinicians who used Guanethidine preferred to use Bretylium but believed it was not available in UK. Most patients were treated weekly. 2. Audit: Bretylium with Prilocaine (90%) or lidocaine (10%) was used. Ninety three percent patients received ketorolac as an adjunct. One received magnesium sulphate. IVRSB showed excellent pain relief in 12%, good pain relief in 12%, and some pain relief in 16%. IVRSB improved limb circulation in 36% and reduction in analgesic requirement in 67% of patients. Conclusion: 1. IVRSB is extensively practiced in UK as an adjunct to pharmacotherapy. It may provide relief of neuropathic pain in some cases. However, evidence of significant benefit is currently lacking. 2. IVRSB with Bretylium and Ketorolac is a low risk and a reasonable option in patients with CRPS. Large studies are required to assess the efficacy and make any guidelines.