345 A Comprehensive Examination of Double-Blind, Randomized Clinical Trials: Local Anesthetics Alone Versus Local Anesthetics Plus Corticosteroids in Low Back Pain Management - Systematic Review and Meta-Analysis

INTRODUCTION: Low back pain (LBP) is a leading cause of disability globally, prompting exploration into effective interventions. This systematic review and meta-analysis aim to evaluate the comparative efficacy of spinal injections using local anesthetics alone (LA) versus local anesthetics combined with corticosteroids (LA+C) for managing LBP. Following PRISMA guidelines, we reviewed randomized controlled trials (RCTs) comparing LA and LA+C, assessing outcomes in pain, disability, and opioid intake at 3, 6, and 12 months. METHODS: We conducted a systematic review following the PRISMA guidelines. The protocol was registered on PROSPERO. The Cochrane risk-of-bias tool for randomized trials version 2 assessed study quality. The primary focus was on double-blind RCTs comparing LA versus LA+C for LBP, with the meta-analysis examining pain, disability, and opioid intake outcomes. RESULTS: The meta-analysis of 16 RCTs (2,312 patients) showed no significant differences in pain relief between LA and LA+C groups at 3, 6, and 12 months. For disability, significant improvements were noted at 6 and 12 months, but not at 3 months. Opioid consumption was similar between groups throughout. Subgroup analysis revealed that patients receiving caudal drug delivery experienced significant disability improvements at all examined time points. However, interlaminar and transforaminal injections did not show significant effects. Patients with disc herniation improved significantly in disability at 3 months, but no differences were found for those with central spinal stenosis. CONCLUSIONS: The addition of corticosteroids to local anesthetics does not enhance pain relief or reduce opioid consumption but significantly improves long-term disability outcomes. However, the injection approach seems to be an important factor regarding this matter. These findings support the selective use of corticosteroids in spinal injections based on individual patient assessments and specific clinical goals.