Role of Caudal epidural and different regional technique blocks in lumbar surgeries: A meta-analysis.

Introduction: Epidural steroid injections (ESIs) are a well-accepted technique for the management of lumbar disc herniation . Three major methods, namely transforaminal epidural steroid injection (TFEI), interlaminar epidural steroid injection (ILEI), and caudal epidural injection (CEI), are commonly used. Aim of the study: to evaluate role and safety of caudal epidural block and other different regional blocks as quadratus lumborum plane block and erector plane block in lumbar spine surgery.Methods: A systematic search conduced 250 records and finally 10 studies were included based on the eligibility criteria. The type of studies comprised RCTs and a retrospective study. Data synthesis Pairwise and network meta-analysis was performed, and heterogeneity was measured using I² values.Results: Short-term effectiveness: TFEI was significantly more effective than CEI in decreasing pain (SMD = – 1.18) and there were no differences between ILEI and either TFEI or CEI. For the long-term pain alleviation, no significant differences between the injection techniques have been assessed (SMD = 0.14). Likewise, superiority of short- and long-term functional disability outcomes could not be demonstrated for any of the three techniques, while high heterogeneity was detected in the included studies. Conclusions: TFEI may provide better short-term pain relief to CEI, but neither technique showed longterm effectiveness and an advantage on reduction of functional disability. High heterogeneity and possible small-study bias suggest that more studies with uniform study protocols and longer follow-up are necessary to increase the evidence base.Keywords; Epidural steroid injection; TFEI; ILEI; CEI; Lumbar disc herniation.