Research on Transforaminal Epidural Blocks

Lidocaine and steroids

A May 2022 paper (1) compared lidocaine to steroids in Transforaminal Epidural Blocks for lumbar disc herniation.

In this study, the researchers noted: “Lumbar transforaminal epidural block (TFEB) is an effective treatment modality for radicular pain due to lumbar disc herniation. The addition of steroids is more effective than local anesthetic alone in Lumbar transforaminal epidural block for patients with lumbar disc herniation. Moreover, the efficacy of Lumbar transforaminal epidural block (TFEB) has been reported to be positively correlated with the volume of injectate. . . This study compared the efficacy of high-volume Lumbar transforaminal epidural block (TFEB) with vs. without steroids for the management of the axial and radicular pain caused by lumbar disc herniation.”

  • A total of 54 patients were randomly assigned to either a group who received lidocaine only or a group that received 8-mL injections of 0.33% lidocaine with 5 mg of dexamethasone.
  • The primary outcomes were pain intensity at baseline and 4 weeks after the procedure.
  • The secondary outcomes included the change of functional disability between baseline and 4 weeks after the procedure, pain scores during injection, and adverse effects.

Results: Both groups showed a significant reduction in axial and radicular pain and improvement in the functional status at the outpatient visit 4 weeks after Lumbar transforaminal epidural block (TFEB). However, there were no significant differences between the groups in terms of changes in back pain or radicular pain. The conclusion was: “High-volume Lumbar transforaminal epidural block (TFEB) with and without steroid administration yielded similar significant pain reductions and functional improvements amonglumbar disc herniation patients 4 weeks after the procedure.

Lumbar radiculopathy

A July 2023 study (2) looked at 294 elderly lumbar radiculopathy patients, treated with transforaminal epidural steroid injections to test the effectiveness of the injections. Treatment success was defined as a more than or equal to 50% reduction in pain scores at 6 months. This study revealed that the patient would have the best results, defined as a more than more than or equal to 50% reduction in pain scores at 6 months with the epidural if their symptoms were treated more quickly (short duration),  if they had a a good immediate postoperative response, and if the had high inflammatory markers (neutrophilic granulocyte percentage)

References

1 Chae JS, Kim WJ, Choi SH. Effects of Local Anesthetics With or Without Steroids in High-Volume Transforaminal Epidural Blocks for Lumbar Disc Herniation: A Randomized, Double-Blind, Controlled Trial. Journal of Korean Medical Science. 2022 May 2;37(17).
2 Wang M, Ling H, Zheng B, Song L. Predictors of a Favorable Response to Transforaminal Epidural Steroid Injections for Lumbar Radiculopathy in the Elderly. Pain Physician. 2023 Jul 1;26(4):347-55. [Google Scholar]

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