The influence of local anesthesia depth on procedural pain during fluoroscopically-guided lumbar transforaminal epidural injections: a randomized clinical trial

Objectives To evaluate the influence of the depth of local anesthesia application on procedural pain during lumbar transforaminal epidural steroid injection (TFESI). Design Sixty-eight patients were enrolled who were scheduled for single-level, unilateral fluoroscopically-guided lumbar TFESI. Patients were randomly allocated to receive either subcutaneous local anesthesia (group S) or deep local anesthesia (group D) for TFESI. The data related to pain and technical performance during the procedure was compared. Additionally, the incidence of injection site soreness was assessed 2 weeks after TFESI. Results Sixty-seven patients completed all assessments (group S, n=33; group D, n=34). There was no significant difference in procedural pain and discomfort level between the groups (P=0.151, P=0.183, respectively). Patients in group D showed lower behavioral pain scores (P=0.017). There was no significant difference in the numbers of needle manipulations, fluoroscopy time, and radiation dose during the procedure between the groups. Two patients in group S and three in group D complained of injection site soreness after TFESI for a few days, but there was no significant difference in its incidence (P=0.667). Conclusions Deep local anesthesia to reduce procedural pain during TFESI appears to have no significant clinical benefit compared with conventional subcutaneous local anesthesia. There is no external funding and no competing interests to declare. This study was registered at ClinicalTrials.gov (ref: NCT03308136). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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