Publication:

Effectiveness and cost-utility of lumbar facet joint blocks using bupivacaine with and without steroid in the treatment of chronic low back pain in adults

Background Chronic low back pain (LBP) causes lot of pain and suffering thus contributing to frequent and increased cost and burden on health-care-facilities. In United Kingdom, it has been estimated that economic cost of LBP pain is around £12.3B per annum. It is also associated with increased incidence of depression, anxiety. These morbidities also lead to increased costs for patient. To study effectiveness and cost-utility of lumbar facet joint blocks using bupivacaine with and without steroid in the treatment of chronic LBP in adults.

Methods Hospital-based randomized comparative study was carried out among 100 adult cases of chronic LBP. They were randomly assigned as 50 cases treated with bupivacaine without steroids and 50 cases treated with bupivacaine with steroids. Modified oswestry disability index was used to assess functional improvement and visual analogue scale to assess pain score. Patient data was used to assess cost-utility.

Results Patients in group-II were significantly older, had more pain duration than group-I. Incidence of repeat procedure required was more in group-I compared to group-II (p 0.05) at baseline. At one, three, six and twelve months, it improved more significantly in group-II compared to group-I (p<0.05). At baseline, pain score was significantly more in group-II compared to group-I (p<0.05). But, at one, three, six and twelve months, it was significantly lesser in group-II compared to group-I (p<0.05). Patients in both groups were comparable for physician cost and facility cost. But total number of procedures and average number of treatments per patient were lesser in group-II compared to group-I.

Conclusions Thus, we conclude that bupivacaine with steroids is not only effective in relief of pain and returning normal functionality, but also cost-effective compared to bupivacaine without steroid in adult patients with chronic LBP.