Epidural Injection With or Without Steroid in Managing Chronic Low-Back and Lower Extremity Pain: A Meta-Analysis of 10 Randomized Controlled Trials

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Abstract

Chronic low-back and lower extremity pain is mainly caused by lumbar disc herniation and radiculitis. Various surgery and nonsurgical modalities, including epidural injections, have been used to treat lumbar disc herniation or radiculitis. Therefore, we conducted this meta-analysis to assess the effects of the 2 interventions in managing various chronic low and lower extremity pain. A systematic literature search was conducted to identify randomized controlled trials, which compared the effect of local anesthetic with or without steroids. The outcomes included pain relief, functional improvement, opioid intake, and therapeutic procedural characteristics. Pooled estimates were calculated using a random-effects or fixed-effects model, depending on the heterogeneity between the included studies. Ten randomized controlled trials (involving 1111 patients) were included in this meta-analysis. The pooled results showed that 41.7% of patients who received local anesthetic with steroid (group 1) and 40.2% of patients who received local anesthetic alone (group 2) had significant improvement in pain relief, and the Numeric Rating Scale pain scales were significantly reduced by 4.09 scores [95% confidence interval (CI), −4.26 to −3.91] and 4.12 (95% CI, −4.35 to −3.89) scores, respectively. Similarly, 39.8% of patients in group 1 and 40.7% in group 2 achieved significantly improved functional status. The Oswestry Disability Indices in the 2 groups were reduced by 14.5 (95% CI, −15.24 to −13.75) and 12.37 (95% CI, −16.13 to −8.62), respectively. The average procedures per year in group 1 were 3.68 ± 1.17 and 3.68 ± 1.26 in group 2, with an average total relief per year of 31.67 ± 13.17 and 32.64 ± 13.92 weeks, respectively. The opioid intake decreased from baseline by 8.81 mg (95% CI, −12.24 to −5.38) and 16.92 mg (95% CI: −22.71 to −11.12) in the 2 groups, respectively. This meta-analysis confirms that epidural injections of local anesthetic with or without steroids have beneficial but similar effects in the treatment of patients with chronic low-back and lower extremity pain.

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