Trigger point injection. This may be effective for relatively isolated points using 5-8 mL of local anaesthetic.
Chymopapain. This enzyme has been advocated for the treatment of acute nuclear herniation that is still intact. The indications are similar for surgical discectomy. However, its use is controversial. Facet joint injection. Corticosteroid injection under radio image intensification is widely used in some clinics. The procedure is delicate and expertise is required. Some good results are obtained. Epidural injections. Injections of local anaesthetic with or without corticosteroids are used, especially for nerve root pain. The author favours the caudal (trans-sacral) epidural injection for persistent sciatica using 15 mL of half-strength local anaesthetic only, e.g. 0.25% bupivacaine (Fig 33.15).
sacral hiatus of aural sac sacral hiatus of aural sac
Fig. 33.15 Caudal epidural injection: the needle should lie free in the space and be well clear of the dural sac
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