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Parasagittal approach better for lumbar injection.

FROM THE ANNUAL MEETING OF THE AMERICAN ACADEMY OF PAIN MEDICINE

PALM SPRINGS, CALIF. - A parasagittal approach - but not a midline mid·line
n.
A medial line, especially the medial line or plane of the body.


midline,
n the line equidistant from bilateral features of the head.
 approach - to interlaminar lumbar epidural epidural /epi·du·ral/ (-dur´il) situated upon or outside the dura mater.

ep·i·du·ral
adj.
Located on or over the dura mater.

n.
 steroid injections for unilateral lumbosacral radiculopathic pain significantly improved quality of life and functionality in a prospective, randomized, single-blind study single-blind study,
n an experiment in which the person collecting the data knows whether the subjects are in the control or experimental groups but the subjects do not.


single-blind study

see blinding.
 of 44 adults.

The steroid injections significantly improved pain in both groups, with Numeric Rating Scale scores during movement decreasing from a preinjection average of 8 in the parasagittal group and 7 in the midline group, to 3 and 4, respectively, on days 1, 7, and 28 after injection. Pain scores at rest fell from 5 in both groups before injection to 3 in the parasagittal group and 4 in the midline group on follow-up days 1, 7, and 28, Dr. Kenneth D. Candido and his associates reported in a prize-winning poster and plenary presentation.

"The analgesic analgesic (ăn'əljē`zĭk), any of a diverse group of drugs used to relieve pain. Analgesic drugs include the nonsteroidal anti-inflammatory drugs (NSAIDs) such as the salicylates, narcotic drugs such as morphine, and synthetic drugs  benefit is profound over the first 30 days; it's about 50%," he said. There have been few previous reports, however, assessing quality of life and functionality after interlaminar lumbar epidural steroid injections, said Dr. Candido of Advocate Illinois Masonic Medical Center, Chicago.

All patients completed the Oswestry Low Back Pain Questionnaire 20 minutes before injection and at each of the follow-ups. The questionnaire is designed to assess how back pain affects patients' ability to manage in everyday life, including personal care, lifting, walking, sitting, standing, sleeping, social life, sex life, and traveling.

Oswestry scores averaged 21 in the parasagittal group and 20 in the midline group before injection, a difference that was not significant.

Scores improved in both groups after injection, but only the parasagittal group showed statistically significant improvements compared with baseline.

Oswestry scores decreased in the parasagittal group from 21 at baseline to approximately 12 on follow-up day 1, and to approximately 10 on days 7 and 28. Oswestry scores in the midline group fell from 20 at baseline to approximately 15 on follow-up day 1, to 13 on day 7, and to 12 on day 28.

Both approaches to lumbar steroid injections are accepted treatments in the conservative care of low back pain with radiculopathy secondary to lumbar disk disease. "I regularly practice both of these," he said.

Patients were randomized to the parasagittal or midline approach. All received 120 mg (2 mL) of methylprednisolone acetate with 1 mL of normal saline and 1 mL of lidocaine lidocaine /li·do·caine/ (li´do-kan) an anesthetic with sedative, analgesic, and cardiac depressant properties, applied topically in the form of the base or hydrochloride salt as a local anesthetic; also used in the latter form as a  1%.

The average age of the patients was 49 years in the parasagittal group and 50 in the midline group. Approximately half in each group were male.

VITALS vi·tals
pl.n.
1. The vital body organs.

2. The parts that are essential to continued functioning, as of a system.
 

Major Finding: In patients with unilateral lumbosacral radiculopathic pain, Oswestry scores decreased in the parasagittal group from 21 at baseline to approximately 12 on follow-up day 1, and to about 10 on days 7 and 28. Oswestry scores in the midline group decreased from 20 at baseline to approximately 15 on follow-up day 1, 13 on day 7, and 12 on day 28.

Data Source: Data are from a prospective, randomized, single-blind study of 44 adult patients who were treated for unilateral lumbosacral radiculopathic pain.

Disclosures: Dr. Candido reported having no financial disclosures.
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Title Annotation:PAIN MANAGEMENT
Author:Boschert, Sherry
Publication:Internal Medicine News
Article Type:Clinical report
Date:Apr 15, 2012
Words:514
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