Background: Transforaminal lumbar epidural steroid injection(TFESI)has been used for treating lumbar radiculopathies.Erector spinae plane block(ESPB)has been used to provide postoperative analgesia following spine and back surgeries.We aimed to compare TFESI with high volume lumbar ESPB in patients with low backache and radicular pain.Methods: This was a prospective,randomized,single centre interventional study.After obtaining institute ethical committee clearance and written informed consent,60 patients aged between 18-50years complaining of unilateral low backache were randomly allocated in 2 groups of 30 each-Group T and group E.Group E received ultrasound guided lumbar ESPB with 30ml of 0.25% bupivacaine with 20mg triamcinolone whereas,group T received fluoroscopy guided TFESI with 2ml of 0.25%bupivacaine with triamcinolone 20mg.The primary outcome was assessment of pain relief by numeric rating scale(NRS)score at 3months.Secondary outcomes assessed were NRS at 1hour and 1month, Modified Oswestry disability Index(MODI),number of patients requiring rescue analgesia and complications of procedures.Results: The mean post procedure NRS at 1hr, 1month and 3month was significantly lower in group T compared to E(p=0.001,0.013 and 0.007 respectively).The MODI was significantly lower in both groups post treatment(p<0.001).In group t 6.9% patient had vasovagal attack and 3.4% had flushing which resolved spontaneously.In contrast no complications were observed in group E.Conclusion: ESP block is effective in providing analgesia in patients with chronic LBP with radiculopathy,however TFESI was better than ESP as evident from more favourable NRS score in TFESI group.However,TFESI requires more precision and expertise and is more likely to cause serious complications.So,ESPB can be given to patients when performing TFESI is difficult or contraindicated.
Keywords: Erector spinae block, Low back pain, Radicular pain, Transforaminal epidural steroid injection.