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Korean J Pain. 2010 Dec;23(4):254-257. English. Original Article.
Nawani DP , Agrawal S , Asthana V .
The Pain Clinic, Doon Nursing Home, Swami Ram Nagar, Dehradun, India.
Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehradun, India.

BACKGROUND: Epidural steroid injection is an established treatment modality for intervertebral disc prolapse leading to radiculopathy. In cases where two levels of radiculopathy are present, two separate injections are warranted. Herein, we present our experience of management of such cases with a single epidural injection of local anaesthetic, tramadol and methylprednisolone, and table tilt for management of both radiculopathies. METHODS: 50 patients of either sex aged between 35-65 years presenting with features of cervical and lumbar radiculopathic pain were included and were subjected to single lumbar epidural injection of local anaesthetic, tramadol and methylprednisolone, in the lateral position. The table was then tilted in the trendelberg position with a tilt of 25 degrees, and patients were maintained for 10 minutes before being turned supine. All patients were administered 3 such injections with an interval of 2 weeks between subsequent injections, and pain relief was assessed with a visual analogue scale. Immediate complications after the block were assessed. RESULTS: Immediate and post procedural complications observed were nausea and vomiting (20%), painful injection site (4%), hypotension (10%) and high block (4%). Pain relief was assessed after the three injections by three grades: 37 (74%) had complete resolution of symptoms; 18% had partial relief and 8% did not benefit from the procedure. CONCLUSIONS: This technique may be used as an alternative technique for pain relief in patients with unilateral cervical and lumbar radiculopathies.

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