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Is the Outcome of Caudal Epidural Injections Affected by Patient Positioning?

Makki, Daoud MD, MRCS, DipSEM(UK&NI); Nawabi, Danyal H. MA, MRCS(Eng), FRCS(Tr&Orth); Francis, Randhir MRCS; Hamed, A. Rami MSc, FRCS(Tr&Orth); Hussein, Ahmed A. FRCS

Spine:
doi: 10.1097/BRS.0b013e3181d41545
Randomized Trial
Abstract

Study Design. A prospective, randomized controlled trial.

Objective. To investigate the effect of the lateral decubitus position, after a caudal epidural injection, on outcome.

Summary of Background Data. Caudal epidural injections are used widely in the treatment of low back pain and radicular leg pain. Various measures have been used to improve the efficacy of these injections in previous studies. Our aim was to investigate the effect of the lateral decubitus position, after administering a caudal epidural injection, on outcome.

Methods. Fifty-seven patients undergoing caudal epidural injection for low back pain associated with radicular leg pain were randomly allocated into 2 groups. Group 1 (treatment group) had 28 patients who were placed in the lateral decubitus position after injection. Group 2 (control group) had 29 patients who were laid supine after injection. Patients were assessed before injection using the Verbal Pain Score (VPS) and the Oswestry Disability Index (ODI). They were reassessed after 6 weeks using the same outcome measures.

Results. Both groups demonstrated improvement after injection. The degree of improvement in the VPS was significantly greater in group 1 compared with group 2 (P = 0.00007). The degree of improvement in the ODI was not statistically significant (P = 0.14).

Conclusion. Laying a patient on the side of their leg pain after a caudal epidural injection has a beneficial effect on the degree of pain relief. We recommend that this simple and safe maneuver be introduced routinely after administering a caudal epidural injection, to aid in the eventual outcome of a potentially difficult clinical problem.

In Brief

This randomized controlled trial investigates the effect of the lateral decubitus position after a caudal epidural injection on outcome. It demonstrates that laying a patient on the side of their leg pain after a caudal epidural injection has a beneficial effect on the degree of pain relief.

Author Information

From the Department of Trauma and Orthopaedic Surgery, Princess Alexandra Hospital NHS Trust, Hamstel Road, Harlow, Essex, United Kingdom.

Acknowledgment date: June 24, 2009. First revision date: September 23, 2009. Second revision date: December 14, 2009. Acceptance date: December 17, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

This trial has been approved by the Local Ethics Committee.

Address correspondence and reprint requests to D. Makki, MD, MRCS, DipSEM(UK&NI), Department of Trauma and Orthopaedics, Princess Alexandra Hospital, Hamstel Road, Harlow, Essex, United Kingdom, CM20 1QX; E-mail: daoudmakki@hotmail.com

© 2010 Lippincott Williams & Wilkins, Inc.