Open AccessThe Noninferiority of the Nonparticulate Steroid Dexamethasone vs the Particulate Steroids Betamethasone and Triamcinolone in Lumbar Transforaminal Epidural Steroid Injections
Author(s) -
ElYahchouchi Christine,
Geske Jennifer R.,
Carter Rickey E.,
Diehn Felix E.,
Wald John T.,
Murthy Naveen S.,
Kaufmann Timothy J.,
Thielen Kent R.,
Morris Jonathan M.,
Amrami Kimberly K.,
Maus Timothy P.
Publication year - 2013
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/pme.12214
Subject(s) - medicine , radicular pain , dexamethasone , betamethasone , epidural steroid injection , anesthesia , triamcinolone acetonide , corticosteroid , lumbar , low back pain , surgery , alternative medicine , pathology
Objective To assess whether a nonparticulate steroid (dexamethasone, 10 mg) is less clinically effective than the particulate steroids (triamcinolone, 80 mg; betamethasone, 12 mg) in lumbar transforaminal epidural steroid injections ( TFESIs ) in subjects with radicular pain with or without radiculopathy. Design Retrospective observational study with noninferiority analysis of dexamethasone relative to particulate steroids. Setting Single academic radiology pain management practice. Subjects Three thousand six hundred forty‐five lumbar TFESIs at the L 4‐5, L 5‐ S 1, or S 1 neural foramina, performed on 2,634 subjects.Methods/Outcome Measures Subjects were assessed with a pain numerical rating scale ( NRS , 0–10) and R oland– M orris disability questionnaire ( R ‐ M ) prior to TFESI , and at 2 weeks and 2 months follow‐up. For categorical outcomes, successful pain relief was defined as either ≥50% reduction in NRS or pain 0/10; functional success was defined as ≥40% reduction in R ‐ M score. Noninferiority analysis was performed with δ = −10% as the limit of noninferiority. Continuous outcomes (mean NRS , R ‐ M scores) were analyzed for noninferiority with difference bounds of 0.3 for NRS scores and 1.0 for R ‐ M scores. Results With categorical outcomes, dexamethasone was demonstrated to be noninferior to the particulate steroids in pain relief and functional improvement at 2 months. Using continuous outcomes, dexamethasone was demonstrated to be superior to the particulate steroids in both pain relief and functional improvement at 2 months. Conclusion This retrospective observational study reveals no evidence that dexamethasone is less effective than particulate steroids in lumbar TFESIs performed for radicular pain with or without radiculopathy.