Side effects and complications of cervical epidural steroid injections

Abstract

Two hundred and four cervical epidural injections of corticosteroids were performed on 142 patients for the treatment of cervical pain over a 1-yr period. Injections were performed at the C7-T1 interspace with 10-15 mL of 0.5% lidocaine containing 1 mg per kg of methylprednisone acetate. Four complications occurred: two dural punctures without sequelae; one episode of upper extremity weakness, which resolved in 24 hr; and one episode of nausea and vomiting lasting 12 hr. In addition, two side effects were frequently reported: stiff neck lasting 12-24 hr occurred in 13.2% of patients, and a mild facial flushing with subjective (but not objective) fever lasting about 12 hr occurred in 9.3% of patients. In this large series, the procedure appears safe to use in an outpatient setting.

Vasovagal Rates in Flouroscopically Guided Interventional Procedures: A Study of Over 8000 Injections

“…The observed 3.5% rate of vv reactions for transforaminal epidural injections is consistent with published reports [2][3][4][5][6]8,9]. This indicates that the relative rates documented between injection types in this study, while specific to a single center, likely reflect those in general practice.…”

“…This discrepancy between procedures may help account for the previously reported variability in interventional procedures between 0% and 8.7% [2][3][4][5][6][7][8][9][10][11][12]. A higher rate with medial branch blocks relative to other axial and appendicular interventions is not surprising because medial branch blocks require needle insertion and advancement to at least two target sites while the others commonly involve a single target.…”

“…vv reactions during spine injections are frequently cited as a common immediate adverse event with a range of reported rates between 0% and 8.7% [2][3][4][5][6][7][8][9][10][11][12][13]. Typical symptoms for vasovagal (vv) reactions include: lightheadedness, dizziness, palpitations, weakness, dimming or blurred vision, nausea and epigastric distress, feeling warm or cold, facial pallor, sweating, dilated pupils, and syncope [14].…”

Eficacia de la metilprednisolona epidural en el dolor radicular

“…The mean age of the patients was 52.8 years (SD ± 15); 52.8% were men. The main diagnosis was lower-limb radicular pain (87.7%).…”

Cervical Foraminal Versus Interlaminar Epidurals: Risks, Benefits, and Alternatives

“…Passage of a catheter provides additional opportunity for trauma to epidural veins and increases hematoma risk, much like continuous epidural access for medication infusions. Plus, multiple prospective studies have demonstrated that the standard interlaminar approach is effective in reducing pain and need for surgeries [8,[79][80][81][82]83 •• ].…”