Management of chronic low backache due to prolapsed intervertebral disc by lumbar versus caudal epidural medications
Sood, J.; Sethi, N. and Kumara, V.P. (2002) Management of chronic low backache due to prolapsed intervertebral disc by lumbar versus caudal epidural medications. First Joint World Congress on Regional Anaesthesia and Pain Therapy,Barecelona 2002.
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Introduction:- The increasing incidence of chronic low backache, its variable character and aetiology makes it lone of the most common and perplexing problems encountered in Pain Relief Clinics. Aim:- The study was conducted to compare the efficacy of medications given either by the lumbar or caudal epidural route for chronic low backache due to prolapsed intervertebral disc. Material and Methods: - A randomized prospective study was conducted on 60 adults who presented to our Pain Relief Clinic for chronic low backache due to prolapsed intervertebral disc proved by prior thorough investigation by an orthopaedic surgeon. They had all received a trial of conservative treatment. The patients were randomly divided into two groups. Group A received 10ml 0.4% lignocaine hydrochloride in normal saline, 80 mgm methyl prednisolone acetate (2ml) and 8 mgm dexamethasone sodium phosphate (2ml) in the epidural space one disc above or below the prolapsed intervertebral disc via the lumbar route. Group B received 25ml 0.4% lignocaine hydrochloride in normal saline and similar doses of steroids via the caudal route. An independent observer assessed pain relief by the straight leg raising test (SLR), visual analogue scale (VAS), the Oswestry low back pain disability ! questionnaire and any complications 48 hours, 96 hours, 1 week and 3 weeks after the injection. The data was analyzed statistically, where p<0.05 was considered significant. Result:- There was a statistically significant improvement (p<0.05) in group A for SLR and VAS as compared to group B. Conclusion:- It is concluded that the lumbar epidural route for therapy is preferable over the caudal for managing chronic low backache due to PIVD.
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