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CASE REPORT
Year : 2014  |  Volume : 28  |  Issue : 2  |  Page : 117-120

Management of failed back surgery syndrome with transforaminal epidural steroid and epidural saline adhesiolysis


Department of Anesthesiology and Pain Management, D. Y. Patil Medical College and Hospital, Kolhapur, Maharashtra, India

Correspondence Address:
Kalpana Rajendra Kulkarni
1168, A-5, "Chaitanya", Takala Square, Kolhapur - 416 008, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-5333.132853

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Failed back surgery syndrome (FBSS) is a condition of persistent pain following spine surgery as a result of epidural adhesions, nerve root entrapment/inflammation. Transforaminal epidural steroid (TFES), interlaminar/caudal epidural (CE) with local anesthetic, saline, steroid and hyaluronidase are established therapeutic options over re-surgery. We report a 55 years old male patient with FBSS since 10 years. Following informed consent, under fluoroscopy guidance TFES given at L4/5, L5/S1 foramina with 1.5 ml 0.25% bupivacaine + triamcinolone 20 mg. Besides, CE injection of 10 ml 0.25% bupivacaine with 50 mcg fentanyl given using 18 gauge Tuohy's needle. Fifteen minutes later 20 ml of 0.9% cold (2°C) normal saline with hyaluronidase (on day 1) was injected forcefully through epidural catheter, repeated on 2 nd and 3 rd day with triamcenolone 20 mg. 90% pain relief persisted till 8 months with improved quality of life. TFES with successive CE saline can be a good therapeutic option for long term relief in FBSS.


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