Open AccessLong-Term Outcomes of Epidurals with Lidocaine With or Without Steroids for Lumbar Disc Herniation and Spinal Stenosis: A Meta-Analysis
Author(s) -
Wang Zhao,
Yong Wang,
Jianping Wu,
Xinyou Gao,
Quanfeng Wei,
Xuezhen Lai,
Jian-Xiong An
Publication year - 2020
Publication title -
pain physician
Language(s) - English
Resource type - Journals
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2020/23/365
Subject(s) - medicine , meta analysis , lidocaine , lumbar spinal stenosis , spinal stenosis , lumbar disc herniation , lumbar , term (time) , stenosis , anesthesia , surgery , radiology , physics , quantum mechanics
Background: Previous meta-analyses examined only the short-term differences betweenlidocaine and steroids vs lidocaine alone in treating lumbar degenerative diseases. Long-termoutcomes (1-2 years) in patients with lumbar disc herniation (LDH) and lumbar central spinalstenosis (LCSS) have not yet been systematically evaluated.Objective: The objective of our study was to assess quantitatively the difference in efficacyat 1 to 2 years between lidocaine alone vs lidocaine and steroids for the management of LDHor LCSS.Study Design: We conducted a meta-analysis.Methods: PubMed, EMBASE, and the Cochrane library were electronically searched up to July22, 2016, for randomized controlled trials comparing lidocaine alone vs in combination withsteroids for the treatment of LDH and LCSS. Effective pain relief (EPR), Numeric Rating Scale(NRS-11), Oswestry Disability Index (ODI), opioid intake (OI), and total employed increasedrate (TEIR) were the endpoints. Risk ratios (RRs) or weighted mean difference (WMD) with95% confidence intervals (CIs) were calculated, and the pooled analysis was conducted usingRevMan 5.2.Results: Seven trials were included. EPR was not significantly different at 1 and 2 years,with RR = 1.08 (95% CI, 0.90-1.30; P = .39) and RR = 1.04 (95% CI, 0.92-1.18; P = .51),respectively, in patients treated with lidocaine alone vs in combination with steroids. The NRS11 was also similar at 1 and 2 years. ODI and OI were not significantly different at 1 and 2years. A similar TEIR effect was also observed for the 2 treatments.Limitations: This meta-analysis relied on a small sample size of trials. Significantheterogeneity among studies was observed. Several significant differences in terms of age ofthe patients were reported in one included trial.Conclusion: This meta-analysis confirmed the similar effects associated with lidocaine alonevs in combination with steroids for the management of LDH and LCSS. Studies with longerfollow-up periods are still recommended.Key words: Effective pain relief, lidocaine, long-term, lumbar central spinal stenosis, lumbardisc herniation, Numeric Rating Scale, opioid intake, Oswestry Disability Index, steroids, totalemployed increased rate