Open AccessAdjuvant Hyaluronidase to Epidural Steroid Improves the Quality of Analgesia in Failed Back Surgery Syndrome: A Prospective Randomized Clinical Trial
Author(s) -
Poupak Rahimzadeh,
Vivek Sharma,
Farnad Imani,
HR Faiz,
Ghodraty Mr,
Nikzad-Jamnani Ar,
Nader Nd
Publication year - 2014
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2014/17/e75
Subject(s) - medicine , analgesic , bupivacaine , anesthesia , randomized controlled trial , back pain , low back pain , surgery , institutional review board , clinical trial , adverse effect , epidural steroid injection , lumbar , triamcinolone acetonide , alternative medicine , pathology
Background: Management of low back pain after spinal surgeries is one of the mostchallenging problems in pain medicine. Transforaminal lumbar epidural steroid injection hasbeen used with inconsistent response. Most patients require multiple and frequent injectionsdue to high recurrence of back pain.Objective: To find out whether the addition of hyaluronidase to the epidural injectate affectsthe quality and duration of analgesia in patients with low back pain secondary to failed backsurgery syndrome.Study Design: Prospective randomized trial.Methods: The study was registered in the Government Clinical Trial registry and the protocolwas reviewed and approved by the institutional review board. After obtaining an informedconsent, 25 patients with low back pain due to failed back syndrome were randomly assignedto receive a transforaminal epidural injection of hyaluronidase 1500 IU (HYL) or normal saline(NSL) to a mixture of bupivacaine 0.5% (1 mL) and triamcinolone 40mg (1 mL) in a doubleblind fashion. An interventional pain specialist using fluoroscopic guidance performed allepidural injections. The patients received a comprehensive neurological examination by anon-interventional pain specialist who was blinded to the treatment during their follow-upvisits, scheduled one, 2, and 4 weeks after the intervention. Numerical pain scores, analgesicrequirement, and satisfaction scores were recorded during every visit.Results: There was no difference in demographic data between the 2 groups. Pain scores andtotal analgesic requirement were significantly lower in the HYL group at 2 and 4 weeks afterblockade (P < 0.01). Patient satisfaction was higher in the HYL group.Limitations: The study was limited by a relatively small sample size.Conclusion: We conclude that adding hyaluronidase to the epidural injectate was effectivein the management of chronic low back pain in patients with failed back surgery syndromedemonstrated over a period of 4 weeks.Key words: Low back pain, lumbar epidural injection, steroid, hyalorunidase, bupivacaine