REVIEWS  ANTALGIC THERAPY Free

Minerva Anestesiologica 2002 July-August;68(7-8):613-20

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: Italian

Clinical use of spinal or epidural steroids

Marinangeli F., Ciccozzi A., Donatelli F., Paladini A., Varrassi G.

Università degli Studi, L’Aquila Dipartimento di Discipline Chirurgiche Cattedra di Anestesia e Rianimazione

Steroids, ­drugs ­with ­potent anti­in­flam­ma­to­ry prop­er­ties on the dam­aged ner­vous ­roots, ­have ­been espe­cial­ly ­used as adju­vants of ­local anes­thet­ics, by spi­nal ­route, in the treat­ments of low-back pain. Spinal ­route was cho­sen to ­obtain a high­er ­local con­cen­tra­tion of ­drug, ­with few system­ic ­side ­effects and to ­improve ­drug’s ­action mech­a­nism. Steroids ­seem to inter­act ­with ­GABA recep­tors and ­thus con­trol neu­ral excit­abil­ity ­through a stab­il­is­ing ­effect on mem­branes, mod­ifi­ca­tion of ner­vous con­duc­tion and mem­brane hyper­po­la­riza­tion, in supras­pi­nal and spi­nal ­site. Epidural ster­oids are espe­cial­ly ­used in the treat­ment of low ­back ­pain due to irri­ta­tion of ner­vous ­roots. They ­have ­been admin­is­tered ­alone or in asso­ci­a­tion ­with ­local anes­thet­ics and/or ­saline solu­tion. Slow release for­mu­la­tions ­have ­been gen­er­al­ly ­used (meth­yl­pred­nis­o­lone ace­tate, and tri­am­cin­o­lone dia­ce­tate). Other indi­ca­tions of epi­du­ral ster­oids are: post­op­er­a­tive hem­i­la­minec­to­my ­pain, pre­ven­tion of ­post her­pet­ic neu­ral­gia, degen­er­a­tive osthe­oar­tri­this. Intra-thecal ster­oids ­have ­been fre­quent­ly ­used in the treat­ment of lum­bar radic­u­lop­a­thy due to dis­co­pa­thy, as an alter­na­tive treat­ment ­when epi­du­ral admin­is­tra­tion is inef­fec­tive. Positive ­results ­have ­been ­obtained ­with meth­yl­pred­nis­o­lone acetate, ­alone or in asso­ci­a­tion ­with ­local anes­thet­ics. Complications relat­ed to intra­spi­nal ster­oids injec­tions are due to exe­cu­tion of the ­block and ­side ­effects of ­drugs. Complica-tions asso­ciat­ed ­with intra­the­cal ster­oids are ­more fre­quent and ­severe ­than epi­du­ral injec­tions and ­include: adhe­sive arach­noid­itis, asep­tic men­in­gi­tis, cau­da equi­na syn­drome. Steroidal tox­ic­ity ­seems to be relat­ed to the poly­eth­y­len­ic gly­cole vehi­cle. Anyway, ­slow ­release for­mu­la­tions con­tain ­less con­cen­trat­ed poly­eth­y­len­ic glycole. The epi­du­ral admin­is­tra­tion, a cor­rect dilu­tion of ster­oid ­with ­local anes­thet­ics solu­tion and/or ­saline solu­tion, and a lim­it­ed num­ber of injec­tions (no ­more ­than ­three) ­allows a sig­nif­i­cant reduc­tion of ster­oid neu­ro­tox­ic­ity.