Lack of Superiority of Epidural Injections with
Lidocaine with Steroids Compared to Without
Steroids in Spinal Pain: A Systematic Review and
Meta-Analysis
Authors: Manchikanti Laxmaiah 
Published: February 2021

Background: Multiple randomized controlled trials (RCTs) and systematic reviews have been
conducted to summarize the evidence for administration of local anesthetic (lidocaine) alone or
with steroids, with discordant opinions, more in favor of equal effect with local anesthetic alone
or with steroids.
Objective: To evaluate the comparative effectiveness of lidocaine alone and lidocaine with
steroids in managing spinal pain to assess superiority or equivalency.
Study Design: A systematic review of RCTs assessing the effectiveness of lidocaine alone
compared with addition of steroids to lidocaine in managing spinal pain secondary to multiple
causes (disc herniation, radiculitis, discogenic pain, spinal stenosis, and post-surgery syndrome).
Methods: This systematic review was performed utilizing Preferred Reporting Items for
Systematic Reviews and Meta-Analysis (PRISMA) for literature search, Cochrane review criteria,
and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias
Assessment (IPM-QRB) to assess the methodologic quality assessment and qualitative analysis
utilizing best evidence synthesis principles, and quantitative analysis utilizing conventional and
single-arm meta-analysis.
PubMed, Cochrane Library, US National Guideline Clearinghouse, Google Scholar, and prior
systematic reviews and reference lists were utilized in the literature search from 1966 through
December 2019. The evidence was summarized utilizing principles of best evidence synthesis on
a scale of 1 to 5.
Outcome Measures: A hard endpoint for the primary outcome was defined as the proportion
of patients with 50% pain relief and improvement in function. Secondary outcome measures, or
soft endpoints, were pain relief and/or improvement in function. Effectiveness was determined
as short-term if it was less than 6 months. Improvement that lasted longer than 6 months, was
defined as long-term.
Results: Based on search criteria, 15 manuscripts were identified and considered for inclusion
for qualitative analysis, quantitative analysis with conventional meta-analysis, and single-arm
meta-analysis. The results showed Level II, moderate evidence, for short-term and long-term
improvement in pain and function with the application of epidural injections with local anesthetic
with or without steroid in managing spinal pain of multiple origins.
Limitations: Despite 15 RCTs, evidence may still be considered as less than optimal and further
studies are recommended.
Conclusion: Overall, the present meta-analysis shows moderate (Level II) evidence for epidural
injections with lidocaine with or without steroids in managing spinal pain secondary to disc herniation, spinal stenosis, discogenic pain, and post-surgery syndrome based on relevant, high-quality
RCTs. Results were similar for lidocaine, with or without steroids.
Key Words: Chronic spinal pain, epidural injections, local anesthetic, lidocaine, steroids, active control
trials, placebo effect