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Papers of the Week

Papers: 25 Apr 2020 - 1 May 2020

Pharmacology/Drug Development


2020 Apr 25

Curr Pain Headache Rep



Does Epidural Bupivacaine with or Without Steroids Provide Long-Term Relief? A Systematic Review and Meta-analysis.


Manchikanti L, Knezevic N N, Parr A, Kaye AD, Sanapati M, Hirsch JA
Curr Pain Headache Rep. 2020 Apr 25; 24(6):26.
PMID: 32335757.


Low back and lower extremity pain have been treated since 1901 with local anesthetics alone and since 1952 in combination with steroids. Over the years, multiple randomized controlled trials, systematic reviews with or without meta-analysis have been reaching discordant conclusions regarding the effectiveness of sodium chloride solution, local anesthetics, and steroids in managing spinal pain. Further, related to lack of understanding, multiple reviewers have considered local anesthetics including lidocaine and bupivacaine as equivalent to placebo based on theory that steroid is the only drug effective in the epidural space. In this review, we assessed effectiveness of epidurally administered bupivacaine with or without steroids to rule out misconceptions of placebo and to show the comparative effectiveness of epidural bupivacaine alone compared to epidural bupivacaine with steroids.