From the Guidelines
Yes, a cervical epidural can be performed without steroid, using only local anesthetics such as lidocaine or bupivacaine to provide pain relief. This procedure, known as a cervical epidural injection or cervical epidural block, involves injecting the anesthetic solution into the epidural space surrounding the spinal cord in the neck region. The duration of pain relief from anesthetic-only injections is typically shorter than steroid-containing injections, usually lasting hours to days rather than weeks. Patients with contraindications to steroids (such as uncontrolled diabetes, infection, or certain allergies) may benefit from this steroid-free approach, as seen in the use of epidural analgesia for postoperative pain relief in rectal surgery 1. The mechanism of action relies solely on the anesthetic blocking pain signals in the nerve roots rather than reducing inflammation as steroids would. However, without the anti-inflammatory effect of steroids, these injections may be less effective for conditions primarily driven by inflammation.
Some studies have shown that epidural analgesia can provide superior pain relief compared to systemic opioids, especially in open rectal surgery 1. Additionally, the use of local anesthetics such as lidocaine has been shown to have anti-inflammatory and opioid-sparing properties, making it a viable option for patients who cannot receive steroids 1. It is essential for healthcare providers to discuss the appropriateness of a steroid-free approach with their patients, considering their specific condition and medical history.
Key points to consider:
- Cervical epidural injections can be performed without steroids using local anesthetics such as lidocaine or bupivacaine.
- The duration of pain relief from anesthetic-only injections is typically shorter than steroid-containing injections.
- Patients with contraindications to steroids may benefit from this steroid-free approach.
- Epidural analgesia can provide superior pain relief compared to systemic opioids, especially in open rectal surgery.
- Local anesthetics such as lidocaine have anti-inflammatory and opioid-sparing properties, making them a viable option for patients who cannot receive steroids.
From the Research
Cervical Epidural Injections Without Steroid
- The effectiveness of cervical epidural injections without steroid has been evaluated in several studies 2, 3, 4.
- A systematic review of cervical interlaminar epidural injections found that the evidence is fair for local anesthetic only, for axial or discogenic pain, spinal stenosis, and postsurgery syndrome 2.
- Another systematic review found that there is Level II evidence for the efficacy of cervical interlaminar epidural injections with local anesthetic with or without steroids, based on at least one high-quality relevant randomized control trial in each category for disc herniation, discogenic pain without facet joint pain, central spinal stenosis, and post surgery syndrome 3.
- A meta-analysis of randomized controlled trials found that the addition of steroids to anesthetic injectates was not associated with better pain and functional score outcomes compared with anesthetic injectate alone in patients with chronic neck pain 4.
- The available evidence suggests that cervical epidural injections can be performed without steroid, and local anesthetic only may be effective for certain conditions, such as axial or discogenic pain, spinal stenosis, and postsurgery syndrome 2, 3, 4.
Comparison of Cervical Epidural Injections With and Without Steroid
- A study compared the effectiveness of cervical epidural injections with local anesthetic with or without steroids for managing chronic neck pain, and found no significant difference in pain relief, functional status, and opioid intake between the two groups 4.
- Another study found that combination treatment with epidural steroid injections and conservative treatment provided better improvement than stand-alone treatment on some measures, but no significant differences were found between treatments for the primary outcome measure 5.
- The evidence suggests that cervical epidural injections with or without steroid may have similar effectiveness for certain conditions, and the decision to use steroid or not may depend on individual patient factors and clinical judgment 2, 3, 4, 5.