Effectiveness of epidural dexamethasone vs triamcinolone to relieve neuropathic pain of cervical disc herniation patients; 3-months follow-up

Abstract

Background & objective: Cervical disc herniation (CDH) is the most common cause of radicular pain; with one-third of the patients suffering for more than six months. Epidural steroid injections (ESI) are widely performed by the pain specialists and the neurosurgeons in this disorder, acute or chronic. We compared triamcinolone and dexamethasone regarding their efficacy to improve neuropathic pain at three months follow-up.  Methodology: This randomized blinded control trial was conducted at Dr. Kariadi Hospital in Semarang, Indonesia, on 42 chronic CDH patients. Patients were divided into two equal groups of 21 each, to receive, interlaminar cervical epidural injections of triamcinolone or dexamethasone under fluoroscopic guidance. The study was conducted from January 2022 to July 2023. Follow-up on the PainDETECT score was carried out before and 3 months after the ESI. Data collected was analyzed by using the Mann-Whitney test (P < 0.05). Results: Forty-two CDH subjects were involved in the study grouped as Dexamethasone group (21) and Triamcinolone group (21). Both groups observed significant pain improvement (P < 0.001, and P = 0.020). In the Dexamethasone group 16 out of 21 (76.2%) subjects showed improvement at 3 months of follow-up in the neuropathic pain, while in Triamcinolone group 10 out of 21 (47.6%) showed improvement at 3 months of follow-up. The differences in the two groups were significant (P < 0.001 vs P = 0.007). Conclusion: The results of this study prove that epidural injection of dexamethasone is more effective than triamcinolone for improving neuropathic pain syndrome associated with chronic cervical disc herniation. Keywords: Chronic CDH, Neck pain, Epidural steroid injection, Dexamethasone, Triamcinolone, Pain DETECT Citation: Budisulistyo T, Yudhasyah RA, Kustiowati E, Husni A, Muhartomo H, Suryadi. Effectiveness of epidural dexamethasone vs triamcinolone to relieve neuropathic pain of cervical disc herniation patients; 3-months follow-up. Anaesth. pain intensive care 2024;28(4):732−736; DOI: 10.35975/apic.v28i4.2515 Received: December 28, 2023; Reviewed: February 12, 2024; Accepted: February 17, 2024