Effect of bupivacaine versus normal Saline in caudal epidural steroid Injection in chronic low back ache: a one Year randomized controlled trial

Abstract

Background and objectives ABSTRACT Epidural steroid injections have been performed for decades and are one of the most common spinal injection procedures performed. This palliative procedure is a safe and effective means for treating low back pain. This study was aimed to compare the effect of Bupivacaine versus Normal Saline in Caudal Epidural Steroid injection in the treatment of chronic low backache. Methodology The present one year randomized controlled trial was conducted at Department of Orthopedics, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum on a total of 60 patients with chronic low backache. Based on the computer generated randomization the selected patients were randomized into two groups namely Group B ( Bupivacaine group) and Group S ( Normal saline group) . The assessment of pain was done based on VAS, disability on ODIS and depression on BDIS. Results In the present study male to female ratio in group B was 2:1 and in group S it was 1.5:1. 50% of patients in group B had right sided radiculopathy and in group S the same was present in 43.33% of patients. The mean duration in group B was 12.63 ± 12.54 months and in group S it was 13.57 ± 12.72 months. The mean pain scores at post injection six months were less in group B ( 2.60 ± 1.28) compared to group S ( 3.00 ± 1.31) . The mean ODIS score at post injection three weeks, three months and six months were significantly less in group B compared to group S ( p<0.001) . The mean BDIS score were comparable in both the groups at post injection three weeks. But at post injection three months and six months mean BDIS iv scores were significantly less in group B compared to group S. Requirement of repeat injection was less in group B ( 13.33% ) compared to group S ( 36.67% ) . Also less number of patients in group B ( 6.67% ) underwent surgery compared to group S ( 13.33% ) . Conclusion and interpretation Overall the present study showed caudal steroid injection with bupivacaine provided better outcome with regards to pain, disability and depression. Also caudal steroid injection with bupivacaine resulted in fewer repeat injections and avoided surgery.