Caudal Epidural Block Outcomes in Economically Active Patients With Low Back Pain
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Published:
Dec 16, 2021
Keywords:
Caudal epidural injection, caudal block, missing working days, low back pain, return-to-work
Main Article Content
Abstract
Introduction: Low back pain is a very common health problem worldwide and a major cause of disability, affecting performance at work and general well-being. It is included in the priority diseases list of the World Health Organization (WHO). Low back pain is one of the leading causes of work absence worldwide. The caudal epidural block is a popular approach in managing lumbar pain conditions in adults.
Materials and Methods: An observational, descriptive, retrospective study was conducted in our institution,from January 2017 to January 2019, on patients who had undergone caudal epidural block for low back pain. We excluded patients with a history of previous epidural blocks, lumbar surgery, or who were lost to follow up. We collected patient demographic and clinical data (including age, sex, etc) and procedure outcomes (pain score, surgery performed, lost working days, and return to work activity).
Results: 38 patients were included. Mean age was 43 (27- 62) years old. Mean pain scores 3 months after treatment were 3.5 (2 – 6) with a difference of 4.5 (IQR -2.7 – -7) from baseline values. This was statistically significant. 55.3% (n=21) of patients returned to active duty in the first month; it is important to note that 52.4% of those (n=11) did it after the first week.
Conclusions: The improvement of pain scores after the procedures was statistically significant. The mean return to work at the end of the first month was 55.3%, and 76.2% of those (N= 16) did it after the first two weeks
Materials and Methods: An observational, descriptive, retrospective study was conducted in our institution,from January 2017 to January 2019, on patients who had undergone caudal epidural block for low back pain. We excluded patients with a history of previous epidural blocks, lumbar surgery, or who were lost to follow up. We collected patient demographic and clinical data (including age, sex, etc) and procedure outcomes (pain score, surgery performed, lost working days, and return to work activity).
Results: 38 patients were included. Mean age was 43 (27- 62) years old. Mean pain scores 3 months after treatment were 3.5 (2 – 6) with a difference of 4.5 (IQR -2.7 – -7) from baseline values. This was statistically significant. 55.3% (n=21) of patients returned to active duty in the first month; it is important to note that 52.4% of those (n=11) did it after the first week.
Conclusions: The improvement of pain scores after the procedures was statistically significant. The mean return to work at the end of the first month was 55.3%, and 76.2% of those (N= 16) did it after the first two weeks
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How to Cite
Besse, M., Baigorria, J. F., Rosado Pardo, J. A., Baldasarre, R., Ambrosini, L., & Sarotto, A. J. (2021). Caudal Epidural Block Outcomes in Economically Active Patients With Low Back Pain. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(6), 763-770. https://doi.org/10.15417/issn.1852-7434.2021.86.6.1339
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Clinical Research
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References
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http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1134-80462012000400003
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15(3):E159-E198. PMID: 22622911
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14. Aggarwal A, Aggarwal A, Harjeet, Sahni D. Morphometry of sacral hiatus and its clinical relevance in caudal
epidural block. Surg Radiol Anat 2009;31(10):793-800. https://doi.org/10.1007/s00276-009-0529-4
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https://www.argentina.gob.ar/sites/default/files/informe_anual_de_accidentabilidad_laboral_-_ano_2017.pdf
https://www.who.int/medicines/areas/priority_medicines/Ch6_24LBP.pdf
2. Duthey B. Update on 2004 Background Paper, BP 6.24 Low back pain. Priority Medicines for Europe and the
World. “A Public Health Approach to Innovation”. WHO. Disponible en:
https://www.who.int/medicines/areas/priority_medicines/BP6_24LBP.pdf
3. Cortiñas Sáenz M, Iglesias Cerrillo JA, Cano Navarro G, Salmerón Cerezuela J, Quirante Pizarro JA, Carricondo
Martínez MI, et al. Bloqueo caudal en dolor crónico lumbar. ¿Es necesario el apoyo radiológico para disminuir los
fallos de la técnica? Rev Soc Esp Dolor 2012;19(4):174-80. Disponible en:
http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1134-80462012000400003
4. Higson RA, Edwuars WB. An analysis of the first ten thousand confinements managed with continuous caudal
analgesia with a report of the authors, first one thousand cases. JAMA 1943;123(9):538-46.
https://doi.org/10.1001/jama.1943.02840440020006
5. Dieng P, Diouf E, Diene JF. Caudal epidural anesthesia in 70 children. Dakar Med 1994;39:95 7. PMID: 7493530
6. Dawkins CJM. An analysis of the complications of extradural and caudal block. Anaesthesia 1969;24(4):554-63.
https//doi.org/10.1111/j.1365-2044.1969.tb02909.x
7. Oliveira CB, Maher CG, Ferreira ML, Hancock MJ, Oliveira VC, McLachlan AJ, et al. Epidural corticosteroid
injections for sciatica. Spine (Phila Pa 1976) 2020;45(21):E1405-E1415. https://doi.org/10.1097/BRS.0000000000003651
8. Conn A, MD, Buenaventura RM, Datta S, Abdi S, Diwan S. Systematic review of caudal epidural injections in the
management of chronic low back pain. Pain Physician 2009;12:109-35. PMID: 19165299
9. Parr AT, Manchikanti L, Hameed H, Conn A, Manchikanti KN, Benyamin RM, et al. Caudal epidural injections
in the management of chronic low back pain: a systematic appraisal of the literature. Pain Physician 2012;
15(3):E159-E198. PMID: 22622911
10. Nandi J, Chowdhery A. RCT to determine effectiveness of caudal epidural steroid injection in lumbosacral sciatica. J Clin Diagn Res 2017;11(2):RC04-RC08. https://doi.org/10.7860/JCDR/2017/21905.9392
11. Kao SC, Lin CS. Caudal epidural block: an updated review of anatomy and techniques. Biomed Res Int 2017;2017: 9217145. https://doi.org/10.1155/2017/9217145
12. Waldman SD. Caudal epidural nerve block: prone position. En: Waldman SD (ed.). Atlas of interventional pain
management. 2nd ed. Philadelphia: Saunders; 2004:380-92.
13. Stitz MY, Sommer HM. Accuracy of blind versus fluoroscopically guided caudal epidural injection. Spine (Phila PA 1976) 1999;24(13):1371-6. https://doi.org/10.1097/00007632-199907010-00016
14. Aggarwal A, Aggarwal A, Harjeet, Sahni D. Morphometry of sacral hiatus and its clinical relevance in caudal
epidural block. Surg Radiol Anat 2009;31(10):793-800. https://doi.org/10.1007/s00276-009-0529-4
15. Low Back Pain Fact Sheet. NIH. NINDS, Publication date December 2014. Publication No. 15-5161. Disponible en: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet
16. Wynne-Jones G, Cowen J, Jordan JL, Uthman O, Main CJ, Glozier N, et al. Absence from work and return to work in people with back pain: a systematic review and meta-analysis. Occup Environ Med 2014;71(6):448-56.
https://doi.org/10.1136/oemed-2013-101571
17. Estadísticas sobre Accidentabilidad Laboral. Ministerio de Trabajo, Empleo y Seguridad Social, Superintendencia de Riesgos del Trabajo 2007. Disponible en:
www.infoleg.gob.ar/basehome/actos_gobierno/actosdegobierno7-12-2009-3.htm
18. Departamento de Estudios y Estadísticas. Informe Anual de Accidentabilidad Laboral 2017. Ciudad Autónoma de Buenos Aires: Superintendencia de Riesgos del Trabajo. Disponible en:
https://www.argentina.gob.ar/sites/default/files/informe_anual_de_accidentabilidad_laboral_-_ano_2017.pdf