Assessing the impact of adding bupivacaine on immediate and delayed post-procedure pain scores in interlaminar epidural steroid injections

• Published in: Skeletal radiology 2022, Vol.51 (1), p.161-169
• Main Authors: Quirk, Cody R., Onofrio, Anthony, Patrie, James T., Nacey, Nicholas C.
• Format: Article
• Language: English
• Subjects: Bupivacaine; Epidural; Imaging; Injection; Local anesthesia; Medicine; Medicine & Public Health; Nuclear Medicine; Orthopedics; Pain; Paralysis; Pathology; Radiology; Scientific Article; Standard components; Steroid hormones; Steroids
• ISSN: 0364-2348; 1432-2161
• DOI: 10.1007/s00256-021-03817-5

Objective A local anesthetic is frequently administered as part of a lumbar epidural steroid injection (LESI); however, there is a rare potential for this to result in transient paralysis if administered incorrectly. The purpose of this retrospective study is to determine if the addition of bupivacaine significantly improves patient-reported pain scores. Materials and methods This retrospective review includes patients undergoing LESI over an approximately 1 year time span. Pre-procedure, immediate post-procedure, and 1-week integer scaled pain scores were recorded. Ordinal regression was used to compare the distributions of the aggregated ordinal pain score categories between bupivacaine- and non-bupivacaine-injected patients. Results Two hundred fifty-eight patients met the inclusion criteria (126F:132 M, mean age 64.7 years) with 164 receiving bupivacaine and steroids and 94 receiving steroids alone. The relative frequency distributions for pre-injection pain did not differ between the bupivacaine patients and the non-bupivacaine patients (p = 0.114). Similarly, the relative frequency distributions for immediate and 1-week post-procedure pain did not differ between the bupivacaine patients and the non-bupivacaine patients (p = 0.293 at immediate time point and p = 0.306 at 1-week time point). Odds ratios comparing pain severity change between the bupivacaine and non-bupivacaine patients also were not significantly different at either the immediate post-procedure (p = 0.769) or 1-week (p = 0.203) time points. Conclusion The lack of a significant downward shift in the bupivacaine patients’ post-procedure pain scores compared to the non-bupivacaine patients’ post-procedure pain scores raises doubts about bupivacaine’s utility as a standard component of a lumbar epidural injection.