Incidence and Characteristics of Complications from Epidural Steroid Injections

McGrath, Jacob M.; Schaefer, Michael P.; Malkamaki, Daniel M.

doi:10.1111/j.1526-4637.2011.01077.x

Cited by 142 publications

(101 citation statements)

References 32 publications

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“…A disadvantage in using epidural anesthesia is the complications that may arise as a result of this route of administration, including postdural puncture headache 10 and increased postprocedural pain. 11 Shafiq et al 12 reported an overall complication rate of 26.6%, including motor block, dural tap, ineffective pain control, accidental catheter pullouts, and problems associated with the delivery system of the drug. In addition to the mode of anesthesia, the follow-up in our report was much longer than that of Aspegren et al Their study reported only a follow-up of 45 days after the post-MUA therapy was complete, 5 whereas ours included pain and disability scores 12 months after post-MUA therapy.…”

Section: Discussionmentioning

confidence: 98%

Manipulation under anesthesia for patients with failed back surgery: retrospective report of 3 cases with 1-year follow-up

Morningstar

Strauchman

2012

Journal of Chiropractic Medicine

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Section: Discussionmentioning

confidence: 98%

Manipulation under anesthesia for patients with failed back surgery: retrospective report of 3 cases with 1-year follow-up

Morningstar

Strauchman

2012

Journal of Chiropractic Medicine

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“…91 No major complications were identified. There were 103 minor complications, for an overall complication per injection rate of 2.4%.…”

Section: Complicationsmentioning

confidence: 98%

“…The TF injection technique involves the placement of a needle within a neuroforamen, does not require a loss-of-resistance technique, and must be performed with fluoroscopic guidance. The TF approach has several theoretical advantages over other routes of injection in that it is the most target-specific, carries a lower risk of inadvertent dural puncture, 91 and is associated with a greater incidence of ventral epidural spread, especially with placement of the needle in the anterior foramen. 92 However, TF ESIs are also associated with an increased risk profile compared with the caudal and IL approaches.…”

Section: Transforaminalmentioning

confidence: 99%

Epidural Steroids

Cohen¹,

Bicket

Jamison

et al. 2013

Regional Anesthesia and Pain Medicine

300

114

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Epidural steroid injections (ESIs) are the most widely utilized pain management procedure in the world, their use supported by more than 45 placebo-controlled studies and dozens of systematic reviews. Despite the extensive literature on the subject, there continues to be considerable controversy surrounding their safety and efficacy. The results of clinical trials and review articles are heavily influenced by specialty, with those done by interventional pain physicians more likely to yield positive findings. Overall, more than half of controlled studies have demonstrated positive findings, suggesting a modest effect size lasting less than 3 months in well-selected individuals. Transforaminal injections are more likely to yield positive results than interlaminar or caudal injections, and subgroup analyses indicate a slightly greater likelihood for a positive response for lumbar herniated disk, compared with spinal stenosis or axial spinal pain. Other factors that may increase the likelihood of a positive outcome in clinical trials include the use of a nonepidural (eg, intramuscular) control group, higher volumes in the treatment group, and the use of depo-steroid. Serious complications are rare following ESIs, provided proper precautions are taken. Although there are no clinical trials comparing different numbers of injections, guidelines suggest that the number of injections should be tailored to individual response, rather than a set series. Most subgroup analyses of controlled studies show no difference in surgical rates between ESI and control patients; however, randomized studies conducted by spine surgeons, in surgically amenable patients with standardized operative criteria, indicate that in some patients the strategic use of ESI may prevent surgery.

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“…Paresthesias or radicular pain occur slightly more frequently with lumbar (13%) compared with cervical (7%) interlaminar ESI [65]. Flushing may occur during both interlaminar and transforaminal injections due to an IgE-mediated mechanism, with rates ranging from as low as 0.1% [67,72] to up to 11% [73], and may be prevented by prophylactic antihistamine medication. Persistent hiccups, likely due to stimulation of the afferent hiccup reflex arc involving either the phrenic, vagus or sympathetic nerves of T6-T12, typically resolve with conservative measures or chlorpromazine (Table 1) [74].…”

Section: Minor Complicationsmentioning

confidence: 99%

Epidural Steroid Injections: An Updated Review on Recent Trends in Safety and Complications

Bicket

Chakravarthy²,

Chang³

et al. 2015

Pain Manag.

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Epidural steroid injections (ESIs), which can provide significant but temporary pain relief in well-selected patients, are the most commonly performed procedure in pain management. The anatomy of the epidural space provides a framework for understanding risks associated with ESIs, a topic relevant to both patients and physicians in interventional pain, surgery and primary care. Safety considerations of epidural steroids include drug preparation and myriad physiological effects stemming from steroid exposure. Although major complications associated with ESI occur rarely, potentially catastrophic events resulting from infectious, hematologic and neurologic morbidity may lead to permanent injury. The safety profile of ESIs may improve with development and dissemination of sound injection technique, safer compounds manufactured in a sterile manner and deficient of thromboembolic potential and the application of existing technology.

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Incidence and Characteristics of Complications from Epidural Steroid Injections

Cited by 142 publications

References 32 publications

Manipulation under anesthesia for patients with failed back surgery: retrospective report of 3 cases with 1-year follow-up

Manipulation under anesthesia for patients with failed back surgery: retrospective report of 3 cases with 1-year follow-up

Epidural Steroids

Epidural Steroid Injections: An Updated Review on Recent Trends in Safety and Complications

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