Ultrasound-guided selective nerve root blocks (USG-SNRBs) versus fluoroscopy-guided selective nerve root blocks (FL-SNRBs) in lumbar radiculopathy using the Kayathwal cocktail: A randomized controlled prospective study

Abstract Background: Lumbar radiculopathy is characterized by pain, numbness, tingling, and weakness, typically in one or both lower limbs, resulting from compression or irritation of a lumbar spinal nerve. Selective nerve root blocks (SNRBs) are a common and effective treatment when conservative measures fail, often serving as an alternative to surgical interventions. This study aims to evaluate the outcomes, advantages, and complications of ultrasound-guided SNRBs (USG-SNRBs) versus fluoroscopy-guided SNRBs (FL-SNRBs). Materials and Methods: This randomized controlled prospective study involved 348 patients diagnosed with lumbar radiculopathy, as confirmed through physical examination and magnetic resonance imaging, conducted between January 2024 and March 2025. Patients who failed conservative treatments were included and treated with SNRBs at various levels using the Kayathwal cocktail. We compared the frequencies of complications, adverse events, and treatment effects, along with functional improvement, at 24 h, 1 month, and 3 months following the injection. Results: The outcomes were assessed using the visual analog scale for pain and the Oswestry Disability Index. These were measured at 24 h, 1 month, and 3 months post-injection. Conclusion: Our results suggest that, compared with FL-SNRB, USG-SNRB has several advantages, including shorter procedure duration, lack of radiation exposure, and absence of dye-related adverse effects, while providing comparable pain relief and functional improvement.