Comparative Efficacy of Methylprednisolone Acetate and Dexamethasone Disodium Phosphate in Lumbosacral Transforaminal Epidural Steroid Injections [Turk J Anaesthesiol Reanim]
Turk J Anaesthesiol Reanim. Ahead of Print: TARD-69741 | DOI: 10.5152/TJAR.2019.69741  

Comparative Efficacy of Methylprednisolone Acetate and Dexamethasone Disodium Phosphate in Lumbosacral Transforaminal Epidural Steroid Injections

Nilay Chatterjee1, Chinmoy Roy2, Samaresh Das1, Wala Al Ajmi1, Naila Salim Al Sharji1, Ahmed Al Mandhari3
1Department of Anaesthesia, ICU and Pain Management, Khoula Hospital, Muscat, Oman
2Department of Pain Management, Royal Hospital, Muscat, Oman
3Department of Anaesthesia, Nizwa Hospital, Oman

Objective: Transforaminal epidural steroid injection (TFESI) is an effective treatment for lumbosacral radicular pain. But in view of accidental intravascular injections and consequent neurological injuries, the safety profile of particulate steroids has been questioned. Dexamethasone (DEXA), being non-particulate, is presumed to be a safe replacement for earlier particulate agents. However, the efficacy of DEXA is still doubtful as compared to particulate steroids. The present study aims to determine the comparative efficacy of DEXA and methylprednisolone (MP) in terms of pain relief and improvement of disability.
Methods: Seventy-six patients were sorted into two groups (MP and DEXA) to receive lumbar TFESI. A protocol of one-time single- or two-level TFESI with equipotent doses of MP or DEXA was followed. Numeric Rating Scale (NRS) and Roland-Morris Disability Questionnaire (RMDQ) scores were collected pre-treatment and at different times for a duration of 6 months at follow-up appointments.
Results: Overall, the extent of pain relief (determined from NRS) and quality of life (determined from RMDQ) were significantly better (p<0.01) in patients belonging to MP group following TFESI. NRS was 2.81.2, 3.31, 5.11.6 and 3.91.4, 4.51.3, 6.21.1 respectively in MP and DEXA group at 1 month, 3 months and 6months of follow-up, whereas RMDQ was 7.92.8, 7.42.3, 8.52.4 and 102.2, 11.42.6, 12.42.7 respectively in MP and DEXA group at similar time points.
Conclusion: The immediate and short term pain relief following TFESI in lumbar radicular pain remained satisfactory and is comparable between MP and DEXA groups, but the long term benefit is significantly more with the use of MP, as evidenced by the NRS and RMDQ scores.

Keywords: Dexamethasone, methylprednisolone, non-particulate steroids, particulate steroids, transforaminal epidural steroid injection




Corresponding Author: Nilay Chatterjee, Oman


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