Comparative Evaluation of Efficacy of Fluoroscopy and Ultrasound for Iliopsoas Block: A Randomised Trial

Objective: To compare analgesic efficacy, improvement in the quality of life, psychology and learning curve for iliopsoas (IP) injection using ultrasound (US) versus fluoroscopy (FL). Methods: Thirty-six patients with chronic low back pain secondary to IP myofascial pain were randomly allocated into two groups and were given IP injection in prone position, using either FL or US as a guide. Pain scores were assessed using numerical rating scale (NRS); learning curve was evaluated by the number of attempts, time taken and subjective ease of performing the procedure. The psychological and quality of life assessment were done using Depression Anxiety Stress Scale (DASS) and Oswestry Disability Index (ODI), respectively. Results: FL and US guided IP injection had equianalgesic efficacy with a decrease in preprocedure NRS pain scores from mean value of 7.06 +/- 0.24 and 6.78 +/- 0.24, respectively, to 2.22 +/- 0.29 and 1.78 +/- 0.26 (at 24 hours), 1.50 +/- 0.22 and 1.50 +/- 0.23 (1 week), 0.50 +/- 0.12 and 0.56 +/- 0.15 (4 weeks) and 0.33 +/- 0.11 and 0.44 +/- 0.15 (12 weeks) (P < .001). The learning curve was easier for US intervention with average attempts of 1-2 compared to 1-3 for FL. The average time taken to perform IP intervention was lesser for US group. The improvement in DASS and ODI was comparable in both groups. Conclusion: FL and US both are effective modalities for IP muscle injection as they provide equal relief from pain, disability and psychological stress. US guided IP injections are easier to learn and perform in comparison with FL.