The efficacy of epidural dexamethasone compared with triamcinolone for radicular pain: a prospective, single-center, randomized trial

BACKGROUND: Low back pain in is one of the most common causes of disability and seeking medical help. Epidural steroid injection can be used when other conservative methods do not help. Epidural corticosteroid injection itself is a conservative method of steroid administration, with or without local anesthetics, directly into the epidural space using various approaches such as interlaminar and transforaminal. The mechanism of action of epidural glucocorticoid administration is mainly anti-inflammatory and anti-edematous. Currently in Russia, no glucocorticoid has epidural administration listed among its clinical indications.

AIM: This trial aimed to compare the efficacy of transforaminal epidural administration of particulate versus non-particulate glucocorticoids in the treatment of radicular pain in the lumbosacral region.

METHODS: The trial included 40 patients who were randomized into 2 groups using the lottery method. The first group (n = 20) received transforminal epidural blocks with non-particulate steroids; the second group (n = 20) received transforminal epidural blocks with particulate steroids. Pain level was assessed using a numerical rating scale, and the Oswestry Disability Index (ODI) was calculated. Normality of data distribution was tested using the Shapiro–Wilk test; differences between groups in quantitative and rank variables were assessed using the Mann–Whitney U test. Microsoft Excel and IBM SPSS Statistics were used for data analysis. Differences were considered significant at p < 0.05.

RESULTS: When comparing the two groups, the pain level on the numerical rating scale in the triamcinolone group decreased over 3 months from 7.5 [7, 8] to 1 [1, 5] points, whereas in the dexamethasone group, pain decreased immediately after treatment from 7 [7, 8] to 1 [1, 1] points, but after 3 months, pain persisted at 4 [1, 6] points. This shows a trend in favor of triamcinolone in the medium term. When comparing the two groups by ODI, a significant reduction in the impact of pain on daily life was observed in both groups.

CONCLUSION: This comparative analysis of the analgesic effect of epidural particulate versus non-particulate steroids revealed a trend toward greater efficacy of epidural particulate glucocorticoids.