Steroids Versus Steroids With Dexmedetomidine In Ultrasound Guided Sacroiliac Joint Injection In Patients With Chronic Low Back Pain

Yehia Kassim, Dina; Gamal Saad, Sherin; Fathy Hassan, Wael

doi:10.21608/ejmr.2021.146084

Steroids Versus Steroids With Dexmedetomidine In Ultrasound Guided Sacroiliac Joint Injection In Patients With Chronic Low Back Pain

Document Type : Original Article

Authors

Anesthesiology, Surgical ICU and Pain Management department, Faculty of Medicine, Beni-Suef University, Egypt

10.21608/ejmr.2021.146084

Abstract

The goal of this study is to evaluate the effect of adding dexmedetomidine as an adjuvant to steroid injection versus steroid alone in chronic low back pain caused by sacroiliac joint arthritis. Sixty patients of both sex, ASA grade 1 and 2, between the ages of 18-70 years, BMI less than 30 kg/m2, after diagnosis of sacroiliac joint dysfunction and failure of conservative management were randomly allocated into two groups (n=30). Group (1): patients received SI injection with 2ml of long-acting corticosteroid (14 mg Betamethasone) and 0.5 ml of normal saline and group (2): patients received SI injection with 2ml of long-acting corticosteroid (14 mg Betamethasone) and 0.5ml dexmedetomidine (50 mcg). Patients were observed for vital signs, pain intensity and possible side effects in the recovery room for 4 hours then discharged. The patient’s pain intensity using Numerical Rating Scale, or functional improvement using Oswestry Disability Index and Functional Rating Scale and complications were followed up at 2 weeks, 4 weeks and 12 weeks. While, short assessment of patient satisfaction was assessed 2 weeks after injection. The results revealed that addition of dexmedetomidine to steroids in sacroiliac joint injection is of low value. There was no statistically significant difference between the steroid group and the dexmedetomidine group regarding the changes in the NRS, ODI and FRI scores at 2 weeks, 4 weeks and 12 weeks after injection.

Keywords

References

1- Slipman CW, Jackson HB, Lipetz JS, Chan KT, Lenrow D, Vresilovic EJ. Sacroiliac joint pain referral zones, Archives of Physical Medicine and Rehabilitation. 2000, Volume 81, Issue 3, Pages 334-338

2- Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic E. The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome. Arch Phys Med Rehabil. 1998 Mar, 79(3), pp 288-92.

3- Song IH, Poddubnyy DA, Rudwaleit M, Sieper J. Benefits and Risks of Ankylosing Spondylitis Treatment With Nonsteroidal Antiinflammatory Drugs, ARTHRITIS & RHEUMATISM. April 2008, Vol. 58, No. 4, pp 929–938

4- Neal JM, Brull R, Horn J, et al. Assessment of Ultrasound-Guided Regional Anesthesia: Executive Summary Regional Anesthesia & Pain Medicine. The Second American Society of Regional Anesthesia and Pain Medicine Evidence-Based Medicine 2016, 41, 181-194.

5- Afonso J, Reis F, Dexmedetomidine: Current Role in Anesthesia and Intensive Care, Brazilian Journal of Anesthesiology, 2012, Volume 62, Issue 1, pages 118-133.

6- Fischer J, Ganellin CR, Analogue-based Drug Discovery, March 2006.

7- Eskandr A, Abdel Maseeh S. The Effect of Dexmedetomidine on Lumbar Epidural Injection for Failed Back Surgery Syndrome. Anesthesiol Res Pract. 2016.

8- Das PB, Samal S. Efficacy of Intra-articular Dexmedetomidine versus Buprenorphine for Postoperative Analgesia following Knee Arthroscopy: A Comparative Study. Anesth Essays Res. 2019, 13(2), 225-228.

9- Moeen SM, Ramadan IK, Elkady HA. Dexamethasone and Dexmedetomidine as an Adjuvant to Intraarticular Bupivacaine for Postoperative Pain Relief in Knee Arthroscopic Surgery: A Randomized Trial. Pain Physician. 2017 Nov, 20(7), 671-680.

10- Manuar MB, Majumdar S, Das A, Hajra BK, Dutta S, Mukherjee D, Mitra T, Kundu R. Pain relief after Arthroscopic Knee Surgery: A comparison of intra-articular ropivacaine, fentanyl, and dexmedetomidine: A prospective, double-blinded, randomized controlled study. Saudi J Anaesth. 2014 Apr, 8(2), 233-7.

11- Mujallid RH, Almarakbi WA, Elshahawy MA, Alhashemi JA. Effects of Intra-articular dexmedetomidine vs bupivacaine on postoperative analgesia in patients undergoing arthroscopic knee surgery, European Journal of Anaesthesiology, June 2011 - Volume 28 - Issue - p 200.

12- Al-Metwalli RR, Mowafi HA, Ismail SA, Siddiqui AK, Al-Ghamdi AM, Shafi MA, El-Saleh AR. Effect of intra-articular dexmedetomidine on postoperative analgesia after arthroscopic knee surgery. Br J Anaesth. Sep. 2008, 101(3), 395-9

13- Wanda J, Neil C, Katharine F, Scott R. Analgesic effect of clonidine added to bupivacaine 0.125% in paediatric caudal blockade. Paediatric anaesthesia. 2004, 14. 483-6.

14- Karabacakoglu A, Karaköse S, Ozerbil OM, Odev K. Fluoroscopy-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with ankylosing spondylitis. Acta Radiol. 2002 Jul, 43(4):425-7.

15- Luukkainen RK, Wennerstrand PV, Kautiainen HH, Sanila MT, Asikainen EL. Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint. Clin Exp Rheumatol. 2002 Jan-Feb; 20(1):52-4.

16- Ojala R, Klemola R, Karppinen J, Sequeiros RB, Tervonen O. Sacro-iliac joint arthrography in low back pain: feasibility of MRI guidance, European Journal of Radiology, 2001, Volume 40, Issue 3, Pages 236-239.

17- Dussault RG, Kaplan PA, Anderson MW. Fluoroscopy-guided sacroiliac joint injections. Radiology. 2000 Jan, 214(1):273-7.

18- Günaydin I, Pereira PL, Daikeler T, Mohren M, Trübenbach J, Schick F, Kanz L, Kötter I. Magnetic resonance imaging guided corticosteroid injection of the sacroiliac joints in patients with therapy resistant spondyloarthropathy: a pilot study. J Rheumatol. 2000 Feb, 27(2), 424-8.

19- Hanly JG, Mitchell M, MacMillan L, Mosher D, Sutton E. Efficacy of sacroiliac corticosteroid injections in patients with inflammatory spondyloarthropathy: results of a 6 month controlled study. J Rheumatol. 2000 Mar, 27(3), 719-22.

20- Maugars Y, Mathis C, Berthelot JM, Charlier C, Prost A. Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double-blind study. Br J Rheumatol. 1996 Aug, 35(8):767-70.

21- Akça Başak, Yılbaş Aysun, Üzümcügil Filiz, Büyükakkuş Berkem, Zırh Elham, Zeybek Dilara, Saricaoglu Fatma. How does intraarticular dexmedetomidine injection effect articular cartilage and synovium? An animal study. BMC anesthesiology. 2010, 20(1) 237.