A comparison of steroid dose with or without local anesthetic in lumbar interlaminar epidural steroid injections

Epidural steroid injections (ESIs) are commonly used as a treatment for lumbar radiculopathy. Currently, most research on comparative efficacy of various steroids in epidural steroid injections is focused on transforaminal ESIs (TFESIs). Through this study, we aimed to compare various steroid doses with or without local anesthetic in interlaminar ESIs (ILESIs).

We reviewed charts for all adult patients who received ILESIs identified by CPT code 62323 between January 2017 to April 2021. Baseline demographic data including age, sex, BMI, and smoking status were recorded. NRS pain scores before the injection and percentage of pain relief at 1-month follow-up were recorded. We compared percentage of patients reporting pain relief at 1 month follow-up of low-dose dexamethasone alone (5 mg), to low-dose dexamethasone mixed with local anesthetic, and to high-dose dexamethasone (10 mg) mixed with local anesthetic, specifically for ILESIs.

Data were available for 311 patients. There was no significant difference in pain relief between the 3 groups at 1 month follow-up. The majority of patients had moderate to significant improvement in pain, supporting the use of ILESIs. Moreover, low-dose steroid with local anesthetic was found to be as efficacious as high-dose steroid alone. Although not statistically significant, the addition of local anesthetic to low-dose or high-dose steroid increased the percentage of patients reporting moderate to significant pain relief.

ILESIs with non-particulate steroids provide moderate to significant pain improvement in the short term, with low-dose steroid mixed with local anesthetic being as efficacious as a high-dose steroid.