Comparison of ultrasound and fluoroscopy-guided caudal epidural block in low back pain with radiculopathy: A randomized controlled study

Abstract

Abstract Background and Aims: Low back pain (LBP) with radiculopathy is a significant global health concern, often leading to reduced quality of life and work absenteeism. Steroid injection using the caudal epidural route offers a non-surgical approach to the management of chronic LBP with radiculopathy. Although fluoroscopy-guided injections are the standard, ultrasound-assisted injection is emerging as an alternative. The aim of this study was to assess and compare the feasibility and effectiveness of caudal epidural blocks assisted by ultrasound versus fluoroscopy in managing LBP with radiculopathy. Material and Methods: A prospective randomized controlled trial was conducted with 30 patients aged 20–80 years suffering from chronic LBP and bilateral radiculopathy. Patients were assigned to ultrasound-assisted (group I) or fluoroscopy-guided (group II) caudal epidural injections. The primary outcome measure was needle placement time. Secondary outcomes included pain assessment, disability evaluation, patient satisfaction, and adverse effects. Statistical analyses were performed using t-tests, ANOVA, and Chi-square tests. Results: The fluoroscopy-guided group exhibited statistically significantly shorter needle placement time (137.13 s) compared to the ultrasound-assisted group (185.60 s) (P < 0.001). Both groups demonstrated significant improvements in pain scores and disability indexes from their respective baselines. Patient satisfaction and adverse effects were comparable between the groups. Conclusion: Although fluoroscopy remains the gold standard for caudal epidural injections, ultrasound-assisted procedures demonstrated comparable pain relief, disability improvement, patient satisfaction, and adverse effects. Ultrasound guidance shows promise as technology and expertise advance, offering a potential alternative for managing LBP with radiculopathy.