The following is a summary of “Comparative-Effectiveness study evaluating outcomes for transforaminal epidural steroid injections performed with 3% hypertonic saline or normal saline in lumbosacral radicular pain,” published in the March 2024 issue of Pain by Munjupong et al.

While transforaminal epidural steroid injections (TFESI) are used for lumbosacral radiculopathy, the effectiveness of adding 3% hypertonic saline for this purpose remains unknown.

Researchers conducted a retrospective study comparing the effectiveness of adding 0.9% saline (control) or 3% hypertonic saline to TFESI for lumbosacral radiculopathy.

They compared TFESI using lidocaine, triamcinolone, and 0.9% NaCl. The main focus was on the percentage of patients reporting a ≥30% pain reduction on a verbal rating scale (VRS; 0–100) after 3 months. Additional criteria included patients with ≥30% pain improvement at 1- and 6-month intervals and those experiencing a ≥15% reduction from baseline on the Oswestry Disability Index (ODI) during follow-up.

The results showed that the H-group had higher pain relief rates compared to the N-group at 3 months (59.09% vs. 41.51%; P=0.002) but not at 1 month (67.53% vs. 64.78%; P=0.61) or 6 months (27.13% vs. 21.55%: P=0.31). Regarding functionality, more responders were observed in the H-group at 3 months (70.31% vs. 53.46%; P=0.002). Factors associated with better outcomes at the 3-month mark included being female, aged ≤ 60 years, and having pain duration ≤ 6 months. While TFESI generally benefited those with herniated discs, the H-group showed superiority only in patients with spondylolisthesis.

Investigators concluded that 3% hypertonic saline showed promise as a replacement for normal saline in TFESI, but further randomized studies are needed to compare it directly to steroids.

Source: academic.oup.com/painmedicine/advance-article/doi/10.1093/pm/pnae019/7633401