Cervical Erector Spinae Plane Block vs. Epidural Steroid Injection for Cervical Radicular Pain: A Clinical Trial.

Abstract

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. Our study compared the efficacy of ICESIs and cervical ESPBs in patients with cervical radicular pain that was refractory to conservative treatment. A randomized, double-blind, controlled trial. 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. 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). 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). The limitations of this study are its short follow-up times and small sample size. 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.