Fluoroscopically Guided Epidural Block in the Thoracic and Lumbar Regions

Nagaro, Takumi; Yorozuya, Toshihiro; Kamei, Michiko; Kii, Norikatsu; Arai, T.; Abe, Syungo

doi:10.1097/00115550-200609000-00003

Cited by 12 publications

(1 citation statement)

References 13 publications

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“…Use of steroid injections has also been extended to zoster-related pain, PHN, spinal compression fractures, and pelvic pain. 2,3 Interestingly, the literature describing the use of epidural steroid injection in acute pain management settings (such as traumatic rib fracture) is generally lacking, irrespective of the length of time from initial injury to initiation of therapy. In our case series, patient 1 received a thoracic epidural steroid injection within 48 hours of the initial insult, while patient 2 a full 3 weeks after his injury.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Epidural Steroid Injection for Rib Fracture Pain

Rauchwerger

Candido

Deer³

et al. 2012

Pain Practice

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Treatment for rib fracture pain can be broadly divided into pharmacologic approaches with oral and/or parenteral medication and interventional approaches utilizing neuraxial analgesia or peripheral nerve blocks to provide pain relief. Both approaches attempt to control nociceptive and neuropathic pain secondary to osseous injury and nerve insult, respectively. Success of treatment is ultimately measured by the ability of the selected modality to decrease pain, chest splinting, and to prevent sequelae of injury, such as pneumonia. Typically, opioids and NSAIDs are the drugs of first choice for acute pain because of ease of administration, immediate onset of action, and rapid titration to effect. In contrast, neuropathic pain medications have a slower onset of action and are more difficult to titrate to therapeutic effect. Interventional approaches include interpleural catheters, intercostal nerve blocks, paravertebral nerve blocks, and thoracic and lumbar epidural catheters. Each intervention has its own inherent advantages, disadvantages, and success rates. Rib fracture pain management practice is founded on the thoracic surgical and anesthesiology literature. Articles addressing rib fracture pain are relatively scarce in the pain medicine literature. As life expectancy increases, and as healthcare system modifications are implemented, pain medicine physicians may be consulted to treat increasing number of patients suffering rib fracture pain and may need to resort to novel therapeutic measures because of financial constraints imposed by those changes. Here we present the first published case series of thoracic epidural steroid injections used for management of rib fracture pain.

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Section: Discussionmentioning

confidence: 99%