Comparison of the Effectiveness of Ultrasound-Guided Periradicular Injections in Patients With Lumbar Radicular Pain

The aim of this study is to evaluate whether the addition of 5% dextrose or 0.9% sodium chloride to a corticosteroid and local anesthetic solution provides additional benefit in patients with unilateral radicular pain due to single-level lumbar disc herniation. The study also evaluates whether these solutions may facilitate separation of the disc material and surrounding soft tissues from the affected nerve root and whether dextrose provides an additional analgesic effect in relieving radicular pain.

The study was designed as a randomized, controlled, prospective, single-blind clinical trial. A total of 33 patients aged 25-65 years with chronic low back pain resistant to conservative treatment and unilateral radicular leg pain, with single-level lumbar disc herniation confirmed by physical examination and magnetic resonance imaging, were included.

Participants were assigned to treatment groups according to a computer-generated randomization scheme. With n = 11 participants in each group, the first group received a total of 3 mL consisting of 1 mL of 0.2% lidocaine hydrochloride and 8 mg/2 mL of dexamethasone. The second group received a total of 10 mL consisting of 1 mL of 0.2% lidocaine hydrochloride, 8 mg/2 mL of dexamethasone, and 7 mL of 5% dextrose. The third group received a total of 10 mL consisting of 1 mL of 0.2% lidocaine hydrochloride, 8 mg/2 mL of dexamethasone, and 7 mL of 0.9% sodium chloride solution.

Participants were unaware of their assigned treatment group. In all participants, injections were administered under sterile conditions in the outpatient interventional procedure room with the participant in the prone position. All procedures were performed under ultrasound guidance using a 1-5 MHz convex probe as a single-session, unilateral, single-level periradicular injection.

Participants were evaluated at four time points: before the injection, 1 hour after the injection, and during face-to-face follow-up visits at 1 and 3 months. The primary outcome measure was pain intensity assessed using the Visual Analog Scale (VAS). Secondary outcome measures included the Oswestry Disability Index (ODI), the Short Form-36, and the amount of analgesic use.

Inclusion criteria

• Age between 25 and 65 years
• Persistent low back and leg pain despite conservative treatment
• Unilateral radicular pain accompanying chronic low back pain lasting longer than 3 months
• Single-level lumbar disc herniation (LDH) confirmed by clinical evaluation and magnetic resonance imaging (MRI)
• Low back pain and unilateral radicular leg pain with a Visual Analog Scale (VAS) score ≥4
• Provision of written informed consent to participate in the study

Exclusion criteria

• Lumbar epidural steroid injection within the previous 6 months or a history of major trauma
• History of allergy to any of the medications to be administered
• Body mass index (BMI) >30 kg/m²
• Unstable chronic medical disease, such as diabetes mellitus, hypertension, or heart failure
• History of lumbar spine surgery
• History of coagulopathy
• History of malignancy
• History of polyneuropathy
• History of peripheral vascular disease
• Presence of a psychiatric disorder or cognitive impairment that would prevent completion of questionnaires and assessment scales, including dementia or significant visual or hearing impairment
• Local infection at the injection site or systemic infection
• Pregnancy and/or breastfeeding
• Neurological deficit in the lower extremities
• Unwillingness to participate in the study