Lumbar interlaminar epidural injections in managing chronic low back pain with sciatica without using fluoroscopy

Objective: to find out the effectiveness of interlaminar parasagittal lumbar epidural injection without using flouroscopy in the management of low back pain with radiculopathy

Study design: descriptive case series

Place and Duration of study: Ziauddin University Hospital Karachi Clifton campus, from January 2013 to December 2014

Methodology: patients with lumbar back pain associated with unilateral sciatica for more than three months duration were included. Visual analogue scale [VAS] of 100 was used for pain severity assessment. Lumbosacral spine x-rays with skin surface marking were obtained before the procedure. Interlaminar parasagittal approach was used in lateral position with affected leg up. Follow up was done at 6 weeks, 3 months, and 6 months. During the course of 6 months, three injections were offered at any point of recurrence of pain with at least 2 to 3 weeks interval

Results: a total of 75 patients of both genders with the mean age of 45.03 +/- 14.35 year were included. Disc levels involved were L4/5 [53.33%], L5/S1 [38.66%], and L3/4 [8%]. Pre-procedural mean VAS score was 75.2 +/-15.99. In 65.33% patients sustained significant relief in pain noted at six months follow up. In 20% patients short term recovery observed with recurrence of pain in three months. No major complication was encountered during the procedure

Conclusion: interlaminar parasagittal epidural injection is simple, effective in relieving chronic low back pain associated with sciatica and does not need any special medical equipments and setup

Challenges in orthopedic surgery: an anesthesiologist's perspective

Orthopedic patients are different from general surgical patients in many aspects; just consider the age factor, as most of these patients report to the treating facility with age specific diseases. The patient concerns are also age specific, ranging from fear of being isolated from the parents, to pain and immobilization and even death. Both, the surgeon and the anesthesiologist have to deal with these concerns. Every age group also comes with its associated comorbid conditions and diseases. Here, it is mainly the anesthesiologist who has to face the music. Old patients have special problems related to comorbid conditions, e.g. hypertension, diabetes, heart disease and lung disease and poly-drug therapy, just to mention few. Perioperative optimization of these patients tests the professional competence of the anesthesiologists. The choice of anesthesia and successful management of perioperative complications will decide the fate of the patient. Regardless of the age, good postoperative nursing care and adequate pain relief will hasten recovery and reduce hospital stay