Sciatica: Treatment With Epidural Injections of Procaine and Hydrocortisone

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INJECTION of procaine hydrochloride containing hydrocortisone acetate into the epidural space via the sacral hiatus helps to relieve sciatica. The purpose of this report is to review the history, technic, results of, and indications for this type of treatment.


The use of the epidural space as a site for the introduction of a therapeutic agent is not new. In 1901, Cathelin,1 reported injecting cocaine through the sacral hiatus in patients with pain of inoperable rectal carcinoma. In 1928, Viner2 reported the similar use of procaine in Ringer's solution to treat sciatica. In 1953, according to Cappio,3 Lièvre and his associates in France reported the introduction of hydrocortisone by the same route on 20 patients. Because of the encouraging results, there have been many published reports from abroad. Recently, Brown4 in this country reported 62 cases with excellent results.

In 1950, we began to treat sciatica with occasional success by introducing 100 ml. of isotonic saline solution through the sacral hiatus. Later on, a smaller quantity of hypertonic saline solution was submitted and procaine hydrochloride was added to reduce the pain of injection. This did not seem to improve the results, so procaine alone was used, followed by straight-leg raising exercises. During the last five years the volume of procaine solution has been reduced to 30 ml. and hydrocortisone acetate has been added with improvement in the results.


The main indication is sciatica of a character indicating pathologic involvement of the spinal nerve roots that contribute to the sciatic . . .



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