• Mehul J Desai, Binit Shah, and Puneet K Sayal.
• Department of Anesthesiology & Critical Care Medicine, George Washington University Medical Center, Washington DC 20037, USA. mdesai@mfa.gwu.edu
• Pain Med. 2011 Jun 1; 12 (6): 864-70.

ObjectiveTo evaluate the relationship between commonly used final needle-tip positions and subsequent contrast flow and patient-reported pain relief in transforaminal epidural steroid injections (TFESIs).DesignRetrospective cross-sectional study.MethodsMedical records of subjects (N = 83) having undergone a TFESI between January 2008 and January 2009 were reviewed to compare TFESIs using the superior-anterior (SA) vs. the superior-posterior (SP) quadrant.Outcome MeasuresOutcome measures included ventral and dorsal epidural contrast flow as well as near-to-complete pain relief as measured by numerical rating scale pain score pre- and post-procedure.ResultsSA TFESIs were associated with greater ventral epidural contrast flow as compared with SP TFESIs (100% vs 61.4%, P < 0.001). SA TFESIs with ventral epidural contrast flow were also associated with flow to a greater number of vertebral levels than SP TFESIs with ventral epidural contrast flow (41% vs 14.8%, P < 0.001). SP TFESIs were associated with greater dorsal epidural contrast flow than SA TFESIs (95.5% vs 43.6%, P < 0.05). SA TFESIs were also associated with a larger proportion of patients who achieved near-to-complete pain relief (P < 0.05) and greater reduction than SP TFESIs in post-procedure pain score relative to pre-procedure (3.3 vs 1.5, P < 0.01).DiscussionThe evolution of TFESIs must balance both safety and efficacy. The efficacy of SA TFESIs is demonstrated to be superior to that of SP TFESIs with regards to ventral epidural flow and patient-reported pain relief. Further efforts should focus on demonstrating efficacy while optimizing safety.Wiley Periodicals, Inc.

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