Efficacy of Sacroiliac Joint Injection With Anesthetic and Corticosteroid: A Prospective Observational Study

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2022 May 13

PMID 35547453

Authors

Siti Nur Fudhlana Ab Aziz

Zamzuri Zakaria Mohamad

Rajandra Kumar Karupiah

Aminudin Che Ahmad

Ahmad Sabri Omar

Affiliations

Soon will be listed here.

Abstract

Sacroiliac joint injection aims to provide pain relief, improve work status, and early return to work. We aimed to investigate the role of corticosteroid and anesthetic mixture to provide short- and long-term pain relief in patients with sacroiliac joint pain. This prospective observational study included 27 patients with sacroiliac joint dysfunction who received a combination of triamcinolone and ropivacaine for sacroiliac joint injection followed by three scheduled visits at four weeks, eight weeks, and six months. The pain was assessed using visual analogue scale (VAS), physician's assessment on the number of positive provocative tests, and patients' self-reported assessment to evaluate their functional outcome. At the four weeks and eight weeks follow up evaluations, the mean VAS reduced from 5.85 (±1.03) at baseline to 3.30 (±1.77) at four weeks, 3.30 (±1.86) at eight weeks, and 3.00 (±1.86) at six months. At each interval, improvement in terms of clinical assessment using a series of provocative tests was seen with a mean of 1.37 (±1.33), 1.63 (±1.31), and 1.48 (±1.05) at four weeks, eight weeks, and six months, respectively. For the functional effectiveness parameters (Roland-Morris questionnaires), the sacroiliac joint (SIJ) injected with these drugs combination showed a more significant improvement in symptoms and function, baseline (13.56±3.36), at four weeks (9.04±3.33), at eight weeks (9.07±4.13), and six months (8.26±4.92). Using the one-way repeated measures ANOVA, the SIJ pain, provocative test, and functional outcome significantly improved over time after injection with triamcinolone and ropivacaine (p<0.001). No complications of the administration of these medications were noted. Our findings support the intermediate-term (six months) effectiveness and safety of a combination of corticosteroid and anesthetic injection for patients with SIJ dysfunction who failed conservative treatment.

Citing Articles

Injective Treatments for Sacroiliac Joint Pain: A Systematic Review and Meta-analysis.

Ruffilli A, Cerasoli T, Barile F, Manzetti M, Viroli G, Traversari M Indian J Orthop. 2024; 58(6):637-649.

PMID: 38812868 PMC: 11130093. DOI: 10.1007/s43465-024-01164-w.

References

Murakami E, Kurosawa D, Aizawa T . Treatment strategy for sacroiliac joint-related pain at or around the posterior superior iliac spine. Clin Neurol Neurosurg. 2018; 165:43-46. DOI: 10.1016/j.clineuro.2017.12.017. View

Liliang P, Lu K, Weng H, Liang C, Tsai Y, Chen H . The therapeutic efficacy of sacroiliac joint blocks with triamcinolone acetonide in the treatment of sacroiliac joint dysfunction without spondyloarthropathy. Spine (Phila Pa 1976). 2009; 34(9):896-900. DOI: 10.1097/BRS.0b013e31819e2c78. View

Luukkainen R, Nissila M, Asikainen E, Sanila M, Lehtinen K, Alanaatu A . Periarticular corticosteroid treatment of the sacroiliac joint in patients with seronegative spondylarthropathy. Clin Exp Rheumatol. 1999; 17(1):88-90. View

Karabacakoglu A, Karakose S, Ozerbil O, Odev K . Fluoroscopy-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with ankylosing spondylitis. Acta Radiol. 2002; 43(4):425-7. DOI: 10.1080/j.1600-0455.2002.430415.x. View

Maugars Y, Mathis C, Berthelot J, Charlier C, Prost A . Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies: a double-blind study. Br J Rheumatol. 1996; 35(8):767-70. DOI: 10.1093/rheumatology/35.8.767. View

Cher D, Polly D, Berven S . Sacroiliac joint pain: burden of disease. Med Devices (Auckl). 2014; 7:73-81. PMC: 3990391. DOI: 10.2147/MDER.S59437. View

Scholten P, Patel S, Christos P, Singh J . Short-term efficacy of sacroiliac joint corticosteroid injection based on arthrographic contrast patterns. PM R. 2014; 7(4):385-91. PMC: 4696761. DOI: 10.1016/j.pmrj.2014.10.007. View

Stratford P, Riddle D . A Roland Morris Disability Questionnaire Target Value to Distinguish between Functional and Dysfunctional States in People with Low Back Pain. Physiother Can. 2016; 68(1):29-35. PMC: 4961316. DOI: 10.3138/ptc.2014-85. View

Cusi M . Paradigm for assessment and treatment of SIJ mechanical dysfunction. J Bodyw Mov Ther. 2010; 14(2):152-61. DOI: 10.1016/j.jbmt.2009.12.004. View

10.

Kamali F, Shokri E . The effect of two manipulative therapy techniques and their outcome in patients with sacroiliac joint syndrome. J Bodyw Mov Ther. 2011; 16(1):29-35. DOI: 10.1016/j.jbmt.2011.02.002. View

11.

Danoff J, Goel R, Sutton R, Maltenfort M, Austin M . How Much Pain Is Significant? Defining the Minimal Clinically Important Difference for the Visual Analog Scale for Pain After Total Joint Arthroplasty. J Arthroplasty. 2018; 33(7S):S71-S75.e2. DOI: 10.1016/j.arth.2018.02.029. View

12.

Luukkainen R, Wennerstrand P, Kautiainen H, Sanila M, Asikainen E . Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint. Clin Exp Rheumatol. 2002; 20(1):52-4. View

13.

Falowski S, Sayed D, Pope J, Patterson D, Fishman M, Gupta M . A Review and Algorithm in the Diagnosis and Treatment of Sacroiliac Joint Pain. J Pain Res. 2020; 13:3337-3348. PMC: 7737553. DOI: 10.2147/JPR.S279390. View

14.

DeLoach L, Higgins M, Caplan A, Stiff J . The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale. Anesth Analg. 1998; 86(1):102-6. DOI: 10.1097/00000539-199801000-00020. View

15.

Kurosawa D, Murakami E, Aizawa T . Groin pain associated with sacroiliac joint dysfunction and lumbar disorders. Clin Neurol Neurosurg. 2017; 161:104-109. DOI: 10.1016/j.clineuro.2017.08.018. View

16.

Robinson H, Brox J, Robinson R, Bjelland E, Solem S, Telje T . The reliability of selected motion- and pain provocation tests for the sacroiliac joint. Man Ther. 2006; 12(1):72-9. DOI: 10.1016/j.math.2005.09.004. View

17.

Nejati P, Sartaj E, Imani F, Moeineddin R, Nejati L, Safavi M . Accuracy of the Diagnostic Tests of Sacroiliac Joint Dysfunction. J Chiropr Med. 2020; 19(1):28-37. PMC: 7646135. DOI: 10.1016/j.jcm.2019.12.002. View

18.

Maugars Y, Mathis C, Vilon P, Prost A . Corticosteroid injection of the sacroiliac joint in patients with seronegative spondylarthropathy. Arthritis Rheum. 1992; 35(5):564-8. DOI: 10.1002/art.1780350512. View

19.

Kennedy D, Shokat M, Visco C . Sacroiliac joint and lumbar zygapophysial joint corticosteroid injections. Phys Med Rehabil Clin N Am. 2010; 21(4):835-42. DOI: 10.1016/j.pmr.2010.06.009. View

20.

Slipman C, Sterenfeld E, Chou L, Herzog R, Vresilovic E . The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome. Arch Phys Med Rehabil. 1998; 79(3):288-92. DOI: 10.1016/s0003-9993(98)90008-9. View