Does a single dose of intravenous dexamethasone reduce Symptoms in Emergency department patients with low Back pain and RAdiculopathy (SEBRA)? A double-blind randomised controlled trial.

Abstract

OBJECTIVE:

To assess the effect of a single dose of intravenous dexamethasone in addition to routine treatment on visual analogue scale (VAS) pain scores at 24 h in emergency department (ED) patients with low back pain with radiculopathy (LBPR).

METHODS:

Double-blind randomised controlled trial of 58 adult ED patients with LBPR, conducted in one tertiary and one urban ED. The intervention was 8 mg of intravenous dexamethasone (or placebo) in addition to current routine care. The primary outcome was the change in VAS pain scores between presentation and 24 h. Secondary outcomes included VAS pain scores at 6 weeks, ED length of stay (EDLOS), straight leg raise (SLR) angles and Oswestry functional scores.

RESULTS:

Patients treated with dexamethasone had a 1.86 point (95% CI 0.31 to 3.42, p=0.019) greater reduction in VAS pain scores at 24 h than placebo (dexamethasone: -2.63 (95% CI -3.63 to -1.63) versus placebo: -0.77 (95% CI -2.04 to 0.51)). At 6 weeks, both groups had similar significant and sustained decrease in VAS scores compared with baseline. Patients receiving dexamethasone had a significantly shorter EDLOS (median: 3.5 h vs 18.8 h, p=0.049) and improved SLR angle at discharge (14.7°, p=0.040). There was no difference in functional scores.

CONCLUSIONS:

In patients with LBPR, a single dose of intravenous dexamethasone in addition to routine management improved VAS pain scores at 24 h, but this effect was not statistically significant at 6 weeks. Dexamethasone may reduce EDLOS and can be considered as a safe adjunct to standard treatment.

TRIAL REGISTRATION NUMBER:

ACTRN12611001020976.

• Authors: Ravichandra Balakrishnamoorthy, Isabelle Horgan, Siegfried Perez, Michael Craig Steele, Gerben B Keijzers
• Journal: Emergency medicine journal : EMJ (Emerg Med J) Vol. 32 Issue 7 Pg. 525-30 (Jul 2015) ISSN: 1472-0213 [Electronic] England
• PMID: 25122642 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Chemical References

• Anti-Inflammatory Agents
• Dexamethasone

Topics

• Administration, Intravenous
• Adult
• Anti-Inflammatory Agents (administration & dosage)
• Dexamethasone (administration & dosage)
• Double-Blind Method
• Emergency Service, Hospital
• Female
• Humans
• Low Back Pain (drug therapy)
• Male
• Middle Aged
• Pain Measurement
• Radiculopathy (drug therapy)
• Young Adult