Clinical Effectiveness of Interlaminar Epidural Injections of Local Anesthetic with or without Steroids for Managing Chronic Neck Pain: A Systematic Review and Meta-Analysis.
机构:[1]Department of Orthopedics and Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA[2]Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt[3]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China首都医科大学附属天坛医院[4]Department of Statistics and Epidemiology, School of Public Health, Capital Medical University, Beijing, China[5]Department of Clinical Sciences, Beijing Friendship Hospital Affiliated- Capital Medical University, Beijing, China首都医科大学附属北京友谊医院[6]Department of Clinical Sciences, Beijing Tongren Hospital Affiliated-Capital Medical University, Beijing, China首都医科大学附属北京同仁医院首都医科大学附属同仁医院[7]Department of Psychology, Emory University, Atlanta, GA, USA[8]Dornsife College of Letters Arts and Sciences, University of Southern California, Los Angeles, CA, USA
Chronic neck pain is reportedly considered the fourth leading cause of disability. Cervical interlaminar epidural injections are among the commonly administered nonsurgical interventions for managing chronic neck pain, secondary to disc herniation and radiculitis, spinal stenosis, or chronic neck pain of discogenic origin.
To systematically review the differences in the effectiveness of cervical epidural injections with local anesthetics with or without steroids for the management of chronic neck pain.
Systematic review and meta-analysis.
A comprehensive search of the literature of randomized controlled trials (RCTs) that compared epidural injections with local anesthetic with or without steroids was performed, including a search of PubMed, EMBASE, and Cochrane databases for all years up to May 2019. Meta-analysis was done for pain relief based on the Numeric Rating Scale, functional status based on the Neck Disability Index, and opioid intake dosage.
Four studies met the inclusion criteria. A total of 370 patients were divided into 2 groups: the experimental group received cervical epidural injection with steroid and local anesthetic, and the control group received injection with local anesthetic only. Regrading pain relief, no significant difference was observed between both groups (weighted mean difference [WMD], -0.006; 95% confidence interval (CI), -0.275 to 0.263; P = 0.963; I² = 0.0% at 12 months). There was also no significant difference in the improvement of the functional status (WMD, 0.159; 95% CI, -1.231 to 1.549; P = 0.823; I² = 9.8% at 12 months). Similarly, there was no significant difference in opioid dosage (WMD, -0.093; 95% CI, -5.952 to 5.766; P = 0.975; I² = 0.0% at 12 months).
Only a few studies on this premise were found in the literature. There was also a lack of heterogeneity of the included RCT studies.
The addition of steroids to anesthetic injectates was not associated with better pain and functional score outcomes compared with anesthetic injectate alone in patients with chronic neck pain.
Chronic neck pain, cervical radiculopathy, cervical disc disease, spinal stenosis, facet joint pathology, cervical epidural injections, steroid injections, local anesthetic injections, systematic review, meta-analysis, randomized control trial.
第一作者机构:[1]Department of Orthopedics and Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA[2]Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt
通讯作者:
通讯机构:[1]Department of Orthopedics and Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA[3]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China[*1]1520 San Pablo St., Suite 2000 Los Angeles, CA 90033, USA
推荐引用方式(GB/T 7714):
Mohamed Kamal Mesregah,Wei Feng,Wei-Hsun Huang,et al.Clinical Effectiveness of Interlaminar Epidural Injections of Local Anesthetic with or without Steroids for Managing Chronic Neck Pain: A Systematic Review and Meta-Analysis.[J].PAIN PHYSICIAN.2020,23(4):335-348.
APA:
Mohamed Kamal Mesregah,Wei Feng,Wei-Hsun Huang,Wei-Cheng Chen,Brandon Yoshida...&Nicholas Van Halm-Lutterodt.(2020).Clinical Effectiveness of Interlaminar Epidural Injections of Local Anesthetic with or without Steroids for Managing Chronic Neck Pain: A Systematic Review and Meta-Analysis..PAIN PHYSICIAN,23,(4)
MLA:
Mohamed Kamal Mesregah,et al."Clinical Effectiveness of Interlaminar Epidural Injections of Local Anesthetic with or without Steroids for Managing Chronic Neck Pain: A Systematic Review and Meta-Analysis.".PAIN PHYSICIAN 23..4(2020):335-348