Supraneural versus infraneural approach to transforaminal epidural steroid injection for unilateral lumbosacral radicular pain (SIAMESE): A study protocol for a randomised non-inferiority trial.

Helen Galley* (Corresponding Author), Rosalind Adam, Malachy O. Columb, Uzunma Onyeakazi, Saravanakumar Kanakarajan

*Corresponding author for this work

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Abstract

Background
Lumbosacral radicular pain is commonly treated by transforaminal steroid epidural injection. There are two methods: the supraneural and the infraneural approaches. The supraneural approach can result in rare but catastrophic consequences from injury to the radiculomedullary artery. The infraneural technique avoids the artery; both approaches show efficacy and are used locally.

Methods
This is a protocol for a randomised, single-blinded, non-inferiority trial of infraneural vs supraneural transforaminal epidural injection for lumbosacral radicular pain at a tertiary referral pain management clinic. Adult patients (n=92) with moderate-to-severe lumbosacral radicular pain of >3 months duration, scheduled for transforaminal epidural steroid injection, will be randomised to epidural by either the infraneural or supraneural approach. Only the treating physicians will know which route is used. The primary outcome measure is the differential impact on pain intensity score at 3 months. Secondary outcome measures will include disability and function scores, sleep and activity measures, and adverse events. Participants will be followed up for 12 months.

Conclusions
This study will determine whether the techniques are comparable and, if so, will enable recommendations for the use of an approach without risk of artery damage and catastrophic injury.
Original languageEnglish
Article number100126
Number of pages7
JournalBJA Open
Volume5
Early online date16 Feb 2023
DOIs
Publication statusPublished - 1 Mar 2023

Bibliographical note

Funding
British Journal of Anaesthesia/Royal College of Anaesthetists, administered by the National Institute of Academic Anaesthesia (WKR0-2021-0004).

Keywords

  • epidural
  • lumbosacral radicular pain
  • non-inferiority
  • randomised controlled trial
  • steroid

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