Serum Triamcinolone Levels Following Interlaminar Epidural Injection

Hooten, W. Michael; Nicholson, Wayne T.; Gazelka, Halena M.; Reid, Joel M.; Moeschler, Susan M.; Lamer, Tim J.

doi:10.1097/aap.0000000000000333

Cited by 22 publications

(23 citation statements)

References 24 publications

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“…The half‐life of triamcinolone following an intra‐articular knee injection ranged from 77 hours to 154 hours . However, in a prospective study of 10 patients with chronic lumbar spine pain, the median half‐life of triamcinolone following a single epidural injection was 523 hours . The half‐life following intra‐articular facet joint injections was between the half‐life of intra‐articular knee and lumbar epidural injections.…”

Section: Discussionmentioning

confidence: 99%

“…The half‐life following intra‐articular facet joint injections was between the half‐life of intra‐articular knee and lumbar epidural injections. The clearance of triamcinolone following an intra‐articular knee injection was determined by first‐order absorption and elimination . However, following epidural administration, clearance was determined by (1) first‐order dissolution from the drug suspension, (2) redistribution and absorption from fat within the epidural space, and (3) elimination .…”

Section: Discussionmentioning

confidence: 99%

“…Serum triamcinolone acetonide and serum cortisol levels were determined using liquid chromatography tandem mass spectrometry (LC‐MS/MS) as previously described . In summary, blood (5 mL) was collected by a trained phlebotomist prior to the intra‐articular facet joint injection and on days 1, 2, 4, 6, 8, 14, 21, 28, 35, and 42 following the procedure.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, the pharmacokinetics of lumbar‐administered epidural triamcinolone acetonide were reported . The elimination half‐life after lumbar epidural administration of triamcinolone was much longer than the elimination half‐life following other routes of administration.…”

Section: Introductionmentioning

confidence: 99%

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Corticosteroid and Cortisol Serum Levels Following Intra‐articular Triamcinolone Acetonide Lumbar Facet Joint Injections

et al. 2018

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The peak serum concentration of triamcinolone following intra-articular facet joint injections occurred within 24 hours. The median terminal elimination half-life was 213 hours, but baseline cortisol levels were suppressed for an average of 4.4 days. Clinically, the prolonged half-life and endocrine effects of triamcinolone could increase the risk for serious drug-drug interactions in patients taking medications that inhibit corticosteroid metabolism.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Corticosteroid and Cortisol Serum Levels Following Intra‐articular Triamcinolone Acetonide Lumbar Facet Joint Injections

et al. 2018

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“…We doubt if the steroid that was injected epidurally prevented the development of HR. A study on the pharmacokinetics of interlaminar epidural triamcinolone showed a median time to maximum concentration of 24.2 hours and a median peak plasma concentration of 4.1 ng/mL 20. Most HRs occur within 1 hour, with 70% of the immediate symptoms occurring within the first 5–15 min 3…”

Section: Discussionmentioning

confidence: 99%

Patients with a history of hypersensitivity reaction to iodinated contrast medium and given iodinated contrast during an interventional pain procedure

Benzon

Schechtman

Zheng

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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In patients with a history of a hypersensitivity reaction to iodinated contrast medium, iodinated contrast medium is avoided, antihistamine and steroid premedication are given, or a gadolinium-based contrast agent is employed. Six patients with a history of a hypersensitivity reaction to iodinated contrast medium and who were not premedicated had an unintentional injection of iodinated contrast. None of the patients developed a moderate or severe reaction. All patients had gadopentetate dimeglumine in one of their injections; three had repeated injections of the gadopentetate. The lack of a significant reaction may be due to any or all of the following: questionable history of iodinated contrast reaction, low dose of iodinated contrast given, concomitant injection of (epidural) steroid, and slower absorption from epidural compared with intravenous injection. While it is reassuring to know that there is a low possibility of a moderate to severe reaction in these patients, every effort should be made to avoid this scenario, appropriate drugs and resuscitation equipment should be immediately available, and the patients should be observed adequately and followed for the possibility of late reactions. Recent publications have called for caution in the use of gadolinium-based contrast agents.

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Systemic Absorption and Side Effects of Locally Injected Glucocorticoids

Stout

Friedly

Standaert

2019

PM&R

110

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Local glucocorticoid injections are often used to treat joint, soft tissue, or spinal pain, but the systemic side effects associated with these injections are poorly understood and not well recognized. There are significant known risks to systemic administration of glucocorticoids. However, there are no guidelines that address issues of systemic absorption, overall systemic risks, or other side effects of locally injected glucocorticoids. For this review, a literature search was performed, and the available evidence on systemic absorption and clinical side effects of intra‐articular and epidural glucocorticoids was synthesized. The goal was to improve clinical understanding of risks associated with these injections. Existing data suggest there is significant individual variability in the amount of systemic absorption and clinical effects of locally injected glucocorticoids. However, it is clear that both intra‐articular and epidural injections can have systemic effects for weeks and that complications may be associated with their use, including Cushing syndrome, loss of bone density, infection, and hyperglycemia. The concurrent use of oral steroids, the number of injections, and the type and dose of glucocorticoids used all are important considerations in estimating risks. The total dose calculation of cumulative glucocorticoid exposure should include all local injections. Caution should be exercised when local glucocorticoid injections are used in higher risk patients, such as postmenopausal women, people with diabetes, and those considering surgery in the near term. Better provider awareness of possible systemic risks should improve decision making and informed consent with patients when considering intra‐articular and epidural steroid injections for painful conditions. Level of Evidence IV

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Serum Triamcinolone Levels Following Interlaminar Epidural Injection

Cited by 22 publications

References 24 publications

Corticosteroid and Cortisol Serum Levels Following Intra‐articular Triamcinolone Acetonide Lumbar Facet Joint Injections

Corticosteroid and Cortisol Serum Levels Following Intra‐articular Triamcinolone Acetonide Lumbar Facet Joint Injections

Patients with a history of hypersensitivity reaction to iodinated contrast medium and given iodinated contrast during an interventional pain procedure

Systemic Absorption and Side Effects of Locally Injected Glucocorticoids

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