Ultrasound Guided Caudal Epidural High Volume and Low Concentration Lidocaine Injection for Lumbar Radiculopathy in Early Pregnancy

The management of lumbar radiculopathy during pregnancy can be challenging for physicians. Thorough evaluations regarding disease severity, the stage of pregnancy and fetal outcome are crucial before appropriate treatments. Here, we present a pregnant woman in her first trimester suffering from incapacitating lumbar radiculopathy. After ruling out surgical indication, we performed a single caudal epidural injection with 20 ml of 0.2% lidocaine under ultrasound (US) guidance. Moreover, Doppler ultrasound was used to confirm the injectate up to the pathologic level. Although pregnancy limited the use of steroids, immediate dramatic pain relief was observed in this patient with only lidocaine injection, and the effect lasted for 4 months. The possible mechanisms of action include anti-inflammatory effect of lidocaine, dilution of inflammatory soup, and natural propensity of the radiculopathy towards clinical improvement. In conclusion, the US-guided caudal epidural injection with low concentration (0.2%) but sufficient volume of lidocaine can be a good therapeutic option for treating intractable sciatic pain during early pregnancy.