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A double-blind comparison of epidural steroids and epidural steroids combined with morphine in the treatment of recurrent low back pain
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POSTERIOR PRIMARY RAMUS BLOCK FOR TREATMENT OF THEIFACET SYNDROME P.S. Thomas, M.D.l, G.W. Stro BP. Frederickson:M.D.2, H.A. YI.I~II,*M. and Orthopedic Surgerya, State Syracuse, NY, 13210, USA Aim of Investigation: Lumbar facet degeneration can cause low back, hip and thigh pain. Each facet is involved with motion of the lower back and, when subluxation occurs, the inferior facet is displaced upward and impinges upon the nerve root located in the inferior vertebral notch. Each facet is innervated by three nerves, two from below and one from above. Various modalities of treatment has been used with varying success. These include radio frequency ablation, phenol injections and cryotherapy. The purpose of this prospective study is to define the clinical indications for posterior primary ramus (PPR) block for treatment of the facet syndrome and to document its effectiveness. Methods: Eighteen patients were treated who had CT scan documentation of lumwt degeneration and symptoms consistant with this diagnosis. The PPR of each involved facet was blocked using bupivicaine 0.5% with methylprednisolone The total volume of three ml was injected under twenty mg as a suspension. fluorcecopic control through a twenty-two gauge three and one half inch spinal needle at two week intervals for a maximum of three blocks. Patients were followed for six months and the results were tabulated for pain relief as per visual pain analog and return to work. Excellent (complete relief) or good (> 75% relief) occured in sixtyResults: The average number of blocks, at two week seven percent of the patients. intervals, was two with a maximum of three. Duration of pain syndrome did not alter the success rate of this regimen. Conclusions: Significant long term pain relief from lumbar facet joint degeneration can be accomplished with correct placement of bupivicaine, 0.5% with methylprednisolone acetate, by blocking the PPR under fluoroscopic control. A DOUBLE-BLIND COMPARISON OF EPIDURAL STEROIDS AND EPIDUPAL
STEROIDS COMBINED WITH MORPHINE IN THE TREATMENT OF RECUR PENT LOW BACK PAIN. A. Rocco, E. Frank,*R. Reisman, W. McKay, and M. Ferrante, Department of Anesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115. Aim of Investigation. Epidural morphine followed by steroid has been reported to be efficacious for recurrent low back pain syndrome. This sudy was undertaken to evaluate this mode of therapy. Method. Thirty patients who had previous laminectomieswere randomly ass-to 3 parallel groups in a double-blind fashion. They received 75 mq of Triamcinolone (Group A), 8 mq of morphine (Group B), or a combination of the two (Group C), epidurally at the level of the pain at monthly inter50 mq. of lidocaine was added to all injections. vals for three months. Pain assessment Patients were admitted to the hospital for 24 hours. started at the time of injection and continued for 6 months; patients were also questioned retrospectively. Twenty-six patients have entered the study, 19 were available Results. Fourteen of these patients had the full series Of for complete analysis. Long-term retrospecFive had 1 or 2 injections. 3 epidural injections. tive questioning from 6 to 18 months following the initial epidural injecNo patient in the morphine or morphine stertions yielded the following: One patient in the steroid group had more than 1 month relief of pain. Five patients had pain relief for 1 to 3 oid group has returned to work. Six patients had improvement for less than 1 week. Two patients weeks. given the morphine and steroid required Naloxone. Conclusion. Our results so far, do not show a beneficial effect of morphine alone or combined with steroid. In addition, ventilatory depression is a hazard.
POSTERIOR PRIMARY RAMUS BLOCK FOR TREATMENT OF THEIFACET SYNDROME P.S. Thomas, M.D.l, G.W. Stro BP. Frederickson:M.D.2, H.A. YI.I~II,*M. and Orthopedic Surgerya, State Syracuse, NY, 13210, USA Aim of Investigation: Lumbar facet degeneration can cause low back, hip and thigh pain. Each facet is involved with motion of the lower back and, when subluxation occurs, the inferior facet is displaced upward and impinges upon the nerve root located in the inferior vertebral notch. Each facet is innervated by three nerves, two from below and one from above. Various modalities of treatment has been used with varying success. These include radio frequency ablation, phenol injections and cryotherapy. The purpose of this prospective study is to define the clinical indications for posterior primary ramus (PPR) block for treatment of the facet syndrome and to document its effectiveness. Methods: Eighteen patients were treated who had CT scan documentation of lumwt degeneration and symptoms consistant with this diagnosis. The PPR of each involved facet was blocked using bupivicaine 0.5% with methylprednisolone The total volume of three ml was injected under twenty mg as a suspension. fluorcecopic control through a twenty-two gauge three and one half inch spinal needle at two week intervals for a maximum of three blocks. Patients were followed for six months and the results were tabulated for pain relief as per visual pain analog and return to work. Excellent (complete relief) or good (> 75% relief) occured in sixtyResults: The average number of blocks, at two week seven percent of the patients. intervals, was two with a maximum of three. Duration of pain syndrome did not alter the success rate of this regimen. Conclusions: Significant long term pain relief from lumbar facet joint degeneration can be accomplished with correct placement of bupivicaine, 0.5% with methylprednisolone acetate, by blocking the PPR under fluoroscopic control. A DOUBLE-BLIND COMPARISON OF EPIDURAL STEROIDS AND EPIDUPAL
STEROIDS COMBINED WITH MORPHINE IN THE TREATMENT OF RECUR PENT LOW BACK PAIN. A. Rocco, E. Frank,*R. Reisman, W. McKay, and M. Ferrante, Department of Anesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115. Aim of Investigation. Epidural morphine followed by steroid has been reported to be efficacious for recurrent low back pain syndrome. This sudy was undertaken to evaluate this mode of therapy. Method. Thirty patients who had previous laminectomieswere randomly ass-to 3 parallel groups in a double-blind fashion. They received 75 mq of Triamcinolone (Group A), 8 mq of morphine (Group B), or a combination of the two (Group C), epidurally at the level of the pain at monthly inter50 mq. of lidocaine was added to all injections. vals for three months. Pain assessment Patients were admitted to the hospital for 24 hours. started at the time of injection and continued for 6 months; patients were also questioned retrospectively. Twenty-six patients have entered the study, 19 were available Results. Fourteen of these patients had the full series Of for complete analysis. Long-term retrospecFive had 1 or 2 injections. 3 epidural injections. tive questioning from 6 to 18 months following the initial epidural injecNo patient in the morphine or morphine stertions yielded the following: One patient in the steroid group had more than 1 month relief of pain. Five patients had pain relief for 1 to 3 oid group has returned to work. Six patients had improvement for less than 1 week. Two patients weeks. given the morphine and steroid required Naloxone. Conclusion. Our results so far, do not show a beneficial effect of morphine alone or combined with steroid. In addition, ventilatory depression is a hazard.