BACKGROUND: Cervical radicular pain is a common chronic pain syndrome, typically managed with conservative treatments. In patients unresponsive to conservative management, minimally invasive interventions, such as an interlaminar cervical epidural steroid injection (ICESI), are employed. The cervical erector spinae plane block (ESPB), initially utilized at the upper thoracic level, has shown promise for managing cervical radicular pain and may serve as an alternative to an ICESI.
OBJECTIVE: Our study compared the efficacy of ICESIs and cervical ESPBs in patients with cervical radicular pain that was refractory to conservative treatment.
STUDY DESIGN: A randomized, double-blind, controlled trial.
SETTING: Rasool Akram Hospital, pain clinic and pain operating room, Department of Anesthesia and Pain Medicine, Iran University of Medical Science, Tehran, Islamic Republic of Iran.
METHODS: In this randomized clinical trial, 30 patients with cervical radicular pain that was unresponsive to conservative therapy were randomized into 2 groups: ICESI Group and ESPB Group. Outcomes were assessed at baseline, and at the 2- and 8 weeks postprocedure follow-ups using the Neck Disability Index (NDI) and the Numeric Rating Scale (NRS-11).
RESULTS: Both groups demonstrated significant reductions in pain intensity and improvements in functional status (P < 0.05). No significant differences in mean (SD) NRS-11 scores were recorded between the groups at 2 weeks (ICESI: 3.93 [1.87] vs. ESPB: 3.73 [1.98], P = 0.778) and 8 weeks (ICESI: 3.53 [2.92] vs. ESPB: 4.93 [3.06], P = 0.211). However, the ICESI group showed significantly greater improvement in mean (SD) NDI scores at both follow-up intervals (11.870 [6.812] vs 19.670 [7.715], P = 0.007, at 2 weeks; 10.070 [8.216] vs 19.000 [9.577], P = 0.011, at 8 weeks follow-up).
LIMITATIONS: The limitations of this study are its short follow-up times and small sample size.
CONCLUSION: Cervical ESPBs are as effective as ICESIs in reducing pain and improving function in patients with cervical radicular pain. Given its comparable efficacy and potentially fewer adverse effects, ESPBs may be considered a suitable alternative to ICESIs in this patient population.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
Regional and epidural blocks are options for the management of severe analgesia-resistant cervical radicular pain. The cervical erector spinae plane block is an alternative to epidural block in high-risk patients.
Physician rater
This small randomised trial provides an interesting signal that bilateral C7 ESPB with steroid may provide clinically useful analgesia for cervical radicular pain and merits further study as a less invasive alternative to cervical epidural injection. However, the conclusion of comparable efficacy is stronger than the data support. This was not designed as a non-inferiority or equivalence trial, and with only 15 patients per group, a non-significant difference in pain scores cannot establish equivalence. Functional outcomes significantly favoured ICESI at both follow-ups, although baseline NDI imbalance complicates interpretation. Similarly, the absence of adverse events cannot establish a safety advantage. This is best regarded as a promising small exploratory RCT rather than evidence that ESPB should replace ICESI.
, McMaster University