Adverse Event Rates Associated with Transforaminal and Interlaminar Epidural Steroid Injections: A Multi-Institutional Study

El-Yahchouchi, Christine; Plastaras, Christopher T.; Maus, Timothy P.; Carr, Carrie M.; McCormick, Zachary L.; Geske, Jennifer R.; Smuck, Matthew; Pingree, Matthew J.; Kennedy, David J.

doi:10.1111/pme.12896

Cited by 54 publications

(60 citation statements)

References 14 publications

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“…Even though the adverse event rates of both approaches were not evaluated in our studies because of a few complications reported and the short-term follow-up time, the choice between ILESI and TFESI should be based on documented efficacy and effectiveness but not driven by safety concerns [49]. Moreover, this meta-analysis was conducted on RCTs and observational studies respectively, and all of them were of high quality.…”

Section: Discussionmentioning

confidence: 98%

Comparison of transforaminal verse interlaminar epidural steroid injection in low back pain with lumbosacral radicular pain: a meta-analysis of the literature

Guo

Liang

Chen

et al. 2016

International Orthopaedics (SICOT)

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Section: Discussionmentioning

confidence: 98%

Comparison of transforaminal verse interlaminar epidural steroid injection in low back pain with lumbosacral radicular pain: a meta-analysis of the literature

Guo

Liang

Chen

et al. 2016

International Orthopaedics (SICOT)

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“…Facial warmth, redness, and flushing may occur 1-2 days after injection, lasting up to 3 days [29]. Psychiatric effects include sleep disturbance and mood change [29,30]. Patients with diabetes predictably experience an elevation in blood glucose levels.…”

Section: Minor Corticosteroid-related Adverse Effectsmentioning

confidence: 99%

“…Allergic reactions and infections are exceptional [30,35]. Epidural abscesses have been reported but are extremely rare, even in immunocompromised patients [30,[36][37][38].…”

Section: Severe Corticosteroid-related Adverse Effectsmentioning

confidence: 99%

Spine Injectables: What Is the Safest Cocktail?

MacMahon

Huang

Palmer

2016

American Journal of Roentgenology

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Nonparticulate preparations, such as dexamethasone, are safer but have shorter-lived antiinflammatory effects. Local anesthetics are often mixed with corticosteroids in pain management procedures. Although everyday risks are minimal, injection techniques should take into account neural and cardiac toxicities. In this article, we discuss the potential for serious adverse events associated with injected medications. We review the current literature to make conclusions on medication combinations that balance safety and efficacy.

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“…However, serious complications of injections below conus-level appear to be rare [16, 17]. Complications of epidural corticosteroids against sciatica are usually limited to nausea, headache, dizziness, vasovagal attacks and flushing of the face [20, 21]. …”

Section: Introductionmentioning

confidence: 99%

Treatment of acute sciatica with transforaminal epidural corticosteroids and local anesthetic: design of a randomized controlled trial

Meulen

Maas

Vyas

et al. 2017

BMC Musculoskelet Disord

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BackgroundTransforaminal epidural injections with steroids (TESI) are used increasingly for patients with sciatica. However there is much debate about their safety and effectiveness. It is important to identify patients that benefit most from TESI and only few trials have yet evaluated the effects in patients with acute sciatica.MethodsWe describe a prospective, randomized controlled trial (RCT), with the aim to evaluate the hypothesis that TESI plus Levobupivacaine (TESI-plus) added to oral pain medication is more effective compared to pain medication alone or compared to transforaminal injection with a local anesthetic of short duration among patients with acute sciatica. We will recruit a total of 264 patients with sciatica (<8 weeks) caused by a herniated disc, from two clinical sites. Participants are randomly assigned one of three study groups: 1) oral pain medication (control group), 2) oral pain medication and TESI-plus (intervention group one), 3) oral pain medication and transforaminal epidural injection (TEI) with Levobupivaine and saline solution (intervention group two). Primary outcomes are functional status (Roland-Morris Disability Questionnaire), pain intensity for both leg and back, (100 mm visual analogous scale (VAS)), and global perceived recovery (GPR, reported on a 7-point Likert scale, dichotomized into ‘recovered’ and ‘not recovered’). The secondary outcomes are health-related quality of life (EQ5D-5 L) and patient satisfaction (7-point Likert scale). We will also collect information on healthcare utilization and costs, to perform an economic evaluation. All outcomes are measured at three and six weeks, three and six months after randomization. We defined a minimal clinically relevant difference between groups as a difference between both intervention groups and the control group of 20 points for pain (100-point VAS), four points for functional status (24-point RDQ) and a 20% difference on dichotomized GPR (recovered versus not recovered).DiscussionA clinically relevant outcome in favor of TESI-plus implies that future patients with acute sciatica should be recommended TESI-plus within the first few weeks rather than being treated with pain medication alone in order to relieve pain and improve their functioning. In case of a negative result (no relevant differences in outcome between the three study arms), pain medication will remain the mainstay of treatment in the acute stages of sciatica.Trial registrationDutch National trial register: NTR4457 (March, 6th, 2014)

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Adverse Event Rates Associated with Transforaminal and Interlaminar Epidural Steroid Injections: A Multi-Institutional Study

Cited by 54 publications

References 14 publications

Comparison of transforaminal verse interlaminar epidural steroid injection in low back pain with lumbosacral radicular pain: a meta-analysis of the literature

Comparison of transforaminal verse interlaminar epidural steroid injection in low back pain with lumbosacral radicular pain: a meta-analysis of the literature

Spine Injectables: What Is the Safest Cocktail?

Treatment of acute sciatica with transforaminal epidural corticosteroids and local anesthetic: design of a randomized controlled trial

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