CAUDAL EPIDURAL BLOCKS FOR ELDERLY PATIENTS WITH LUMBAR CANAL STENOSIS

Objective: To determine the efficacy of caudal epidural blocks (CEB) i n relieving pain and the duration of pain relief with CEB in elderly p atients suffering from degenerative lumbar canal stenosis (LCS). Desig n: This study was a descriptive, prospective study with a 10-month fol low-up. Participants and Setting: Thirty patients, 76 +/- 6.7 years of age, with leg discomfort with or without back pain and with LCS docum ented by magnetic resonance imaging (MRI) within I year of the study, were recruited from the outpatient clinic of the Cleveland Clinic Flor ida. None of the subjects had received CEB or surgery for their leg di scomfort and none had relief of pain by analgesics alone. Measurements and Interventions: Subjects received a total of three doses of 0.5% X ylocaine with 80 mg Depo-Medrol into the caudal epidural space through the sacral hiatus at weekly intervals. The Roland 5-point pain rating scale was utilized before and at 2-month intervals up to 10 months af ter the CEB was administered. MRI was used to identify the degree of L CS. Results: The degree of LCS on admission was moderate in 66.7% (n = 20) of the patients, mild in 23.3% (n = 7), and severe in the remaini ng 10% (n = 3). Patients had LCS involving 2.4 +/- 0.49 lumbar vertebr ae. The degree of LCS is directly correlated with the pain level befor e CEB. After CEB, the pain level changed from 3.43 +/- 0.82 to 1.5 +/- 0.86 (P < 0.0000), with a significant relief of pain up to 10 months (the end of observation). The duration of pain relief ranged from 4 to 10 months (P < 0.0001). Conclusion: CEB offers significant pain relie f and appears to be a reasonable therapeutic option among elderly pati ents with LCS. This alternative seems particularly important among pat ients with poor response to drug therapy and who are either poor surgi cal risks or who have refused surgery.