• Makkar Jeetinder Kaur JK Department of Anesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India., Balbir Kumar, Kajal Jain, Saravdeep S Dhutt, Y K Batra, and Preet Mohinder Singh.
• Department of Anesthesia and Intensive care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
• Pain Physician. 2018 May 1; 21 (3): 243-250.

BackgroundEpidural steroids injections (ESI) are frequently used to treat lumbar radicular pain. Although different volume have been used for interlaminar ESI in adults, there is no controlled trial comparing the effect of different volumes on pain relief for the same dose of steroid .ObjectiveTo compare the effect of increase in volume of epidural drug on pain relief in lumbar ESI.Study DesignRandomized double blind trial SETTING: Pain OR of a tertiary care centre METHODS: Sixty patients were randomly allocated to 1 of 3 groups: Group A (4 mL), Group B (6 mL), and Group C (8 mL). Pain was evaluated using visual analog scale (VAS) and improvement in disability using modified Oswestry Disability Questionnaire scores (MODQS) at 2, 4, 8, 12, and 24 weeks. Patients having less than 50% pain relief from baseline received an additional epidural injection of the same volume with a maximum of 3 injections at least 15 days apart. The primary objective of the study was incidence of patients attaining more than 50% pain relief at 6 months. Secondary outcome included MODQS and pattern of spread of iodinated contrast on fluoroscopy.ResultsAt the end of 6 months, there was no significant difference in the effective pain relief between the 3 groups (Group A-16/22 (72.7%), Group B-15/20 (75%), Group C-13/18 (72.2%); P = 0.98, chi- square test). All groups demonstrated a significant reduction in mean VAS scores. There was no significant intergroup difference in VAS sores and MODQS at all the time intervals. The pattern of contrast spread did not differ between the 3 groups.LimitationNot a placebo controlled trial.ConclusionsAn increase in volume of the injectate from 4 mL to 8 mL did not increase the efficacy of interlaminar ESI.Key WordsEpidural steroid, volume, low back pain, interlaminar.

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