Ultrasound-guided cervical selective nerve root block with or without steroid.

Abstract

Purpose: To compare short-term pain trajectories after ultrasound (US)-guided cervical selective nerve root block (SNRB) using a steroid-containing injectate versus a no-steroid injectate in patients with cervical radicular pain.

Methods: This single-center prospective comparative study used time-period-based allocation of injectate. Consecutive patients undergoing a first-time US-guided cervical SNRB between 2021 and 2024 were reviewed. The steroid group received 1% lidocaine 1 mL + normal saline 2 mL + betamethasone 4 mg (1 mL). The no-steroid group received 1% lidocaine 1 mL + normal saline 3 mL. Pain intensity was assessed using the numerical rating scale (NRS; 0-10) at baseline, 15 min, day 1, day 2, and day 14. The primary analysis used a mixed model for repeated measures (MMRM) with group, time, and group-by-time interaction; the primary estimand was the between-group difference in change from baseline to day 14. Secondary analyses estimated between-group differences at each post-baseline time point. Safety outcomes included procedure-related complications and 3-month clinical course.

Results: Of 97 screened patients, 70 were analyzed (steroid: n = 43, no-steroid: n = 27). Baseline NRS was similar (6.98 ± 2.38 vs 6.93 ± 2.29). The group-by-time interaction was significant (p = 0.0036). At day 14, the steroid group showed greater improvement than the no-steroid group (MMRM between-group difference in change: - 1.55; p = 0.0077). Model-based differences favored steroid from 15 min through day 14. No procedure-related complications occurred; six patients underwent surgery during 3-month follow-up.

Conclusion: In US-guided cervical SNRB, adding betamethasone was associated with superior short-term pain improvement without observed complications.