Acute treatment of facet syndrome by CT-guided injection of dexamethasone-21-palmitate alone and in combination with mepivacaine

Objective: To compare the efficacy and tolerability of dexamethasone-21-palmitate and mepivacaine alone and in combination in the acute treatment of facet syndrome. Patients and methods: A total of 157 patients requiring acute therapy for lumbar facet syndrome were treated with computed tomography (CT)-guided intra-articular infiltration of either an anti-inflammatory corticosteroid, a local anaesthetic or a combination of the two. Patients assigned to the first treatment group (n = 60) received the corticosterod dexamethasone-21-palmitate (LLipotalon((R))); patients in the second group (n = 36) received the local anaesthetic mepivacaine (Meaverin((R))); patients in the third group (n = 6 1) received a combination of the two drugs. The study duration was from November 2002 until June 2003. Results: In all three groups, values for compression pain, stress pain and rest pain improved significantly from baseline within I hour of injection: in the dexamethasone monotherapy group there was a 13% reduction in compression pain, 20% reduction in stress, and 22% reduction in rest pain; in the groups that received mepivacaine only or a combination of the two drugs there was a 63% and 60%, respectively, reduction of compression pain, 81% and 83%, respectively, reduction of stress pain, and 84% and 77%, respectively, reduction of rest pain. After 72 hours, improvements in these variables were significantly greater in patients treated with dexamethasone-21-palmitate (either as monotherapy or in combination therapy) than in patients treated with mepivacaine alone. In both groups treated with dexamethasone palmitate there was a 57% and 64%, respectively, reduction of compression pain, 70% and 66%, respectively, reduction of stress pain, and 75% and 64%, respectively, reduction of rest pain. In the mepivacaine monotherapy group there was a 17% reduction in compression pain, 26% reduction in stress pain and 13% reduction in rest pain. Both physicians and patients also rated the dexamethasone-21-palmitate-containing regimens as more effective than mepivacaine alone at 72 hours. Over the entire observation period, combina-tion therapy was, on average, superior to both monotherapy regimens. The proportion of patients using concomitant NSAID medication after 3 days was reduced by 50% in the mepivacaine group and by 76% and 100%, respectively, in the dexamethasone-21-palmitate and combination therapy groups. CT-guided infiltration treatment was well tolerated and was associated with virtually no side effects in this study. Conclusion: CT-guided infiltration of dexamethasone palmitate, particularly in combination with mepivacaine, represents a safe and effective method for the acute therapy of lumbar facet syndrome. The combination is superior to the local anaesthetic alone with regard to pain reduction up to 3 days after injection.