Actualidad en el tratamiento de la sacrolumbalgia vía peridural
Palabras clave:
Sacrolumbalgia, corticoesteroides, inyección epidural, transforaminal, interlaminar, ketamina, neostigmina, dexmetomidina clorhidrato.Resumen
La Sacrolumbalgia se caracteriza por la presencia de dolor agudo o crónico
de la columna lumbosacra provocado por diferentes causas que se acompaña
frecuentemente de dolor irradiado o referido. Los corticoides son los antiinflamatorios
más eficaces: pueden inhibir las manifestaciones inmediatas y tardías de la
inflamación, inhiben la vasodilatación, disminuyen la trasudación líquida y el edema,
reducen el exudado celular y el depósito de fibrina en el área inflamada. En este
artículo, se hablará de las ultimas actualizaciones en manejo de la sacrolumbagia por
vía epidural, según sus características clínicas la causa de dicho dolor, se hizo una
revisión de aproximadamente 300-400 artículos entre 2018 y enero de 2021 en la base
de datos de Pubmed, encontrándose que los diferentes tipos de corticoides son los
más usados en las técnicas que se manejan para sacrolumbalgia vía epidural.
Citas
Oliveira CB, Maher CG, Ferreira ML, Hancock MJ, Oliveira VC, McLachlan AJ, et al. Epidural corticosteroid injections for lumbosacral radicular pain. Cochrane Database Syst Rev. 2020;4(4):CD013577. doi: 10.1002/14651858.CD013577.
J Am Osteopath Assoc. Platelet-Rich Plasma and Epidural Platelet Lysate: Novel Treatment for Lumbar Disk Herniation. 2020;1;120(3):201-207. doi: 10.7556/jaoa.2020.032.
Zargar S, Rafie AN, Sosanabadi A, Kamali AJ Addition of dexmedetomidine and neostigmine to 1.5 % lidocaine and triamcinolone for epidural block to reduce the duration of analgesia in patients suffering from chronic low back pain. Med Life. 2019;12(3):260-265. doi: 10.25122/jml-2019-0043.
Kawu AA. Epidural steroid injection in patients with lumbosacral radiculopathy in Abuja, Nigeria. J Neurosci Rural Pract 2012;3:121-125.
Patel K, Chopra P. Upadhyayula Epidural Steroid Injections. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. PMID: 29262183
Braunwald E, Fauci A, Kasper D, Hauser S, Longo D, Jameson J. Harrison: Principios de Medicina Interna (15º ed). Madrid, España: McGraw-Hill. 2002:100-105
Gupta R, Kaur H, Kaur S, Mahajan L, Kaur T. Indian J Anaesth. To compare the analgesic efficacy of two different doses of epidural ketamine in chronic low back-pain patients: A randomised double-blind study. 2020;64(9):768-773. doi: 10.4103/ija.IJA_541_20.
Boswell MV, Hansen HC, Trescot AM, et al. Epidural steroids in the management of chronic spinal pain and radiculopathy. Pain Physician. 2003;6:319–34
Epidural Steroid and Facet Injections for Spinal Pain. UnitedHealthcare® Commercial Medical Policy. 2020. Available at: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/epidural-steroid-facet-injectionsspinal-pain.pdf.
Baek IC, Choi SY, Suh J, Kim SH. The Influence of Local Anesthesia Depth on Procedural Pain During Fluoroscopically Guided Lumbar Transforaminal Epidural Injections: A Randomized Clinical Trial. American Journal of Physical Medicine & Rehabilitation 2019;98(4):253-257.
Choi EJ, Park SJ, Yoo YM, Yoon JU, Shin SW, Byeon GJ. Comparison of the Oblique Interlaminar and Transforaminal Lumbar Epidural Steroid Injections for Treatment of Low Back and Lumbosacral Radicular Pain. Pain Res. 2021;14:407-414. doi: 10.2147/JPR.S293166.
Knezevic NN, Manchikanti L, Urits I, Orhurhu V, Vangala BP, Vanaparthy R, et al. Lack of Superiority of Epidural Injections with Lidocaine with Steroids Compared to Without Steroids in Spinal Pain: A Systematic Review and Meta-Analysis. Pain Physician. 2020;23(4S):S239-S270.
Knezevic NN, Jovanovic F, Voronov D, Candido KD. Do Corticosteroids Still Have a Place in the Treatment of Chronic Pain? Front Pharmacol. 20181;9:1229. doi: 10.3389/fphar.2018.01229.
Lee JH, Sim KC, Kwon HJ, Kim JW, Lee G, Cho SS, et al. Medicine. Effectiveness of lumbar epidural injection in patients with chronic spinal stenosis accompanying redundant nerve roots. 2019;98(9):e14490. doi: 10.1097/MD.0000000000014490.
Chang MC, Lee DG. Outcome of Transforaminal Epidural Steroid Injection According to the Severity of Lumbar Foraminal Spinal Stenosis. Pain Physician. 2018;21(1):67-72.
Kennedy DJ, Zheng PZ, Smuck M, McCormick ZL, Huynh L, Schneider BJ. A minimum of 5-year follow-up after lumbar transforaminal epidural steroid injections in patients with lumbar radicular pain due to intervertebral disc herniation. Spine J 2018;18:29-35.
Glémarec J, Varin S, Cozic C, Tanguy G, Volteau C, Montigny P, et al. EKicacy of local glucocorticoid aQer local anesthetic in low back pain with lumbosacral transitional vertebra: a randomized placebo-controlled double-blind trial. Joint, Bone, Spine 2018;85(3):359-63.
Shrestha P, Subba L, Agrawal P, Lohani S. Outcome of transforaminal epidural steroid injection for lumbar radiculopathy: initial three-year experience at Upendra Devkota Memorial-National Institute of Neurological and Allied Sciences, Nepal. Chin Neurosurg J. 2020;6:6. doi: 10.1186/s41016-020-0184-5.
Ehlert D, Majjhoo A. Traumeel Epidural Injection: A Viable Alternative to Corticosteroids-A Five-Patient Case Study. Cureus. 2019;11(11):e6196. doi: 10.7759/cureus.6196.
Oriol-López SA, Maldonado-Sánchez KA, Hernández-Bernal CE, Castelazo-Arredondo JA, Moctezuma R. Dexmedetomidina peridural en anestesia regional para disminuir la ansiedad. 2008;31(4):271-277
Manchikanti L, Singh V, Falco FJ, Cash KA, Pampati V. Evaluation of the effectiveness of lumbar interlaminar epidural injections in managing chronic pain of lumbar disc herniation or radiculitis: a randomized, double-blind, controlled trial. Pain physician. 2010;13(4):343–55
Chang MC, Lee DG. Outcome of Transforaminal Epidural Steroid Injection According to the Severity of Lumbar Foraminal Spinal Stenosis. Pain Physician. 2018;21:67–72
North American Spine Society. Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care: Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy. 2012. Available at: https://www.spine.org/Portals/0/assets/downloads/ResearchClinicalCare/Guidelines/LumbarDiscHerniation.pdf .
Schaaf S, Huang W, Perera S, Conley Y, Belfer I, Jayabalan P, et al. Association of Protein and Genetic Biomarkers With Response to Lumbar Epidural Steroid Injections in Subjects With Axial Low Back Pain, Am J Phys Med Rehabil. 2021;100(1):48–56.
Turner JA, Comstock BA, Standaert CJ, et al. Can patient characteristics predict benefit from epidural corticosteroid injections for lumbar spinal stenosis symptoms? Spine J 2015;15:2319–31
Bahar-Ozdemir Y, Sencan S, Ercalik T, Kokar S, Gunduz OH. The Effect of Pre-Treatment Depression, Anxiety and Somatization Levels on Transforaminal Epidural Steroid Injection: A Prospective Observational Study. Pain Physician. 2020;23(3):E273-E280
Makkar JK, Gourav KKP, Jain K, Singh PM, Dhatt SS, Sachdeva N, Bhadada S. Transforaminal Versus Lateral Parasagittal Versus Midline Interlaminar Lumbar Epidural Steroid Injection for Management of Unilateral Radicular Lumbar Pain: A Randomized Double-Blind Trial, Pain Physician 2019;22(6):561-573.
Knezevic NN Jovanovic F, Voronov D, Candido KD. Do Corticosteroids Still Have a Place in the Treatment of Chronic Pain? Front Pharmacol. 20181;9:1229. doi: 10.3389/fphar.2018.01229.
Hasoon J, Urits I, Burroughs M, Cai V, Orhurhz V, Aner M, et al. Epidural Blood Patch does not Contribute to the Development of Chronic Low Back Pain in Patients who Undergo Lumbar Punctures: A Pilot Study. Psychopharmacol Bull. 2020;15;50(4 Suppl 1):17-24.
Kim M, Yang YH, Son HJ, Huh J, Cheong Y, Kang SS, Hwang B. Effect of medications and epidural steroid injections on fractures in postmenopausal women with osteoporosis. Medicine. 2019;98(26):e16080. doi: 10.1097/MD.0000000000016080.7
Chang MC, Lee DG. Outcome of Transforaminal Epidural Steroid Injection According to the Severity of Lumbar Foraminal Spinal Stenosis. Pain Physician. 2018;21(1):67-72.
Manchikanti L, Sanapati MR, Pampati V, Boswell MV, Kaye AD, Hirsch JA. Update on Reversal and Decline of Growth of Utilization of Interventional Techniques In Managing Chronic Pain in the Medicare Population from 2000 to 2018. Pain Physician. 2019;22(6):521-536.
Evran S, Kayhan A, Baran O, Saygi T, Katar S, Akkaya E, Ozbek MA, Çevik S. The Synergistic Effect of Combined Transforaminal and Caudal Epidural Steroid Injection in Recurrent Lumbar Disc Herniations. Cureus. 2021;13(1):e12538. doi: 10.7759/cureus.12538.
Yildizgoren MT. Ultrasound-guided caudal epidural injection in three simple steps. Med Ultrason. 2020;22(2):254-255. doi: 10.11152/mu-2466.
Makkar JK, Kumar B, Jain K, Dhutt SS, Batra YK, Singh PM. Effect of Different Volumes on Pain Relief in Patient Receiving Fluoroscopic Guided Interlaminar Lumbar Epidural Steroid Injection. Pain Physician. 2018;21(3):243-250
Donohue NK, Tarima SS, Durand MJ, et al. Comparing pain relief and functional improvement between methylprednisolone and dexamethasone lumbosacral transforaminal epidural steroid injections: a self-controlled study. Korean J Pain. 2020;33(2):192–8.
Park K, Kim S. Digital subtraction angiography vs. real-time fluoroscopy for detection of intravascular injection during transforaminal epidural block. Yeungnam Univ J Med. 2019;36(2):109–14.
Chatterjee N, Roy C, Das S, et al. Comparative efficacy of methylprednisolone acetate and dexamethasone disodium phosphate in lumbosacral transforaminal epidural steroid injections. Turk J Anaesthesiol Reanim. 2019;47(5):414–9.
Buenaventura RM, Datta S, Abdi S, Smith HS. Systematic review of therapeutic lumbar transforaminal epidural steroid injections. Pain Physician. 2009;12:233–5.
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