18 trials (1179 participants) were included in this updated review . The injection sites varied from epidural sites and facet joints (. intra-articular injections, peri-articular injections and nerve blocks) to local sites (. tender- and trigger points). The drugs that were studied consisted of corticosteroids, local anesthetics and a variety of other drugs. The methodological quality of the trials was limited with 10 out of 18 trials rated as having a high methodological quality. Statistical pooling was not possible due to clinical heterogeneity in the trials. Overall, the results indicated that there is no strong evidence for or against the use of any type of injection therapy .
The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.
Participants on corticosteroids were 11% less likely to experience adverse events, but confidence intervals included the null effect ( RR , 95% CI to , I 2 =0%). Participants on corticosteroids were 67% less likely to withdraw because of adverse events, but confidence intervals were wide and included the null effect ( RR , 95% CI to , I 2 =0%). Participants on corticosteroids were 27% less likely to experience any serious adverse event, but confidence intervals were wide and included the null effect ( RR , 95% CI to , I 2 =0%).