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Injection Complications and Management

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Pain Management and Palliative Care

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Abstract

Generally, epidural injections, facet joint injections, and radio-frequency ablation neurectomies are safe procedures with rare minor adverse effects and rarer major complications. Although minor side effects are more frequently reported, including increased low back pain, numbness, paresthesia, flushing, and injection site discomfort, they raise concern for major complications. Clinicians are often faced with difficult decisions regarding the urgency of re-evaluation and the need for emergency imaging studies for prompt treatment to avoid long-term neurological deficit. Awareness of the nature and frequency of these complications may help in clinical decision-making.

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Abbreviations

ASA:

Aspirin

CRP:

C-reactive protein

CSF:

Cerebrospinal fluid

CT:

Computed tomography

DSA:

Digital subtraction angiography

EMLA:

Lidocaine 2.5 % and prilocaine 2.5 %

ESI:

Epidural spinal injections

ESR:

Erythrocyte sedimentation rate

IV:

Intravenous

IVIG:

Intravenous immunoglobulin

MPA:

Methylprednisolone acetate

MRI:

Magnetic resonance imaging

NSAIDs:

Nonsteroidal anti-inflammatory drugs

PDPH:

Post-dural puncture headache

PO:

Per os

SI:

Sacroiliac

TEN:

Toxic epidermal necrolysis

US:

Ultrasound

References

  1. Landa J, Kim Y. Outcomes of interlaminar and transforaminal spinal injections. Bull NYU Hosp Jt Dis. 2012;70(1):6–10.

    PubMed  Google Scholar 

  2. McGrath JM, Schaefer MP, Malkamaki DM. Incidence and characteristics of complications from epidural steroid injections. Pain Med. 2011;12(5):726–31.

    Article  PubMed  Google Scholar 

  3. Gahleb A, et al. Post-dural puncture headache. Int J Gen Med. 2012;5:45–51.

    Article  Google Scholar 

  4. Turnbulland DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003;91(5):718–29.

    Article  Google Scholar 

  5. Benzon H, et al. Essentials of pain management. New York: Elsevier; 2011.

    Google Scholar 

  6. Blume JE, et al. Drug eruptions treatment & management. Medscape: http://emedicine.medscape.com/article/1049474-treatment

  7. Even JL, et al. Effects of epidural steroid injection on blood glucose levels in patient with Diabetes Mellitus. Spine. 2012;37(1):E46–50.

    Article  PubMed  Google Scholar 

  8. Wheeless’ Orthopedic textbook of Orthopaedics, 2008. http://www.wheelessonline.com/ortho/blood_supply_of_the_spinal_cord

  9. Ward A, Watson J, Wood P, Dunne C, Kerr D. Glucocorticoid epidural for sciatica: metabolic and endocrine sequelae. Rheumatology (Oxford). 2002;41(1):68–71.

    Article  CAS  Google Scholar 

  10. Abassi A, et al. Persistent hiccups after interventional pain procedures. PM R. 2012;4:144–51.

    Article  Google Scholar 

  11. Rajput D, et al. Spinal epidural lipomatosis: an unusual cause of relapsing and remitting paraparesis. J Pediatr Neurosci. 2010;5(2):150–2.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Choi KC, et al. Rapid progression of spinal epidural lipomatosis. Eur Spine J. 2012;21(4):408–12.

    Article  PubMed Central  Google Scholar 

  13. Brinda Vihari SOMANCHI, Saeed MOHAMMAD. Raymond ROSS an unusual complication following caudal epidural steroid injection: a case report. Acta Orthop Belg. 2008;74:720–2.

    Google Scholar 

  14. Shanthanna H, Park J. Acute epidural haematoma following epidural steroid injection in a patient with spinal stenosis. Anaesthesia. 2011;66(9):837–9.

    Article  CAS  PubMed  Google Scholar 

  15. Simon DL, et al. Allergic or pseudoallergic reaction following epidural steroid deposition and skin testing? Reg Anesth. 1989;14:253–5.

    CAS  PubMed  Google Scholar 

  16. Neal JM, Rathmell JP. ASRA practice advisory on neurologic complications in regional anesthesia and pain medicine. Reg Anesth Pain Med. 2007;33:404–15.

    Article  Google Scholar 

  17. Kainer MA, Reagan DR, Nguyen DB, Wiese AD, Wise ME, Ward J, Park BJ, Kanago ML, Baumblatt J, Schaefer MK, Berger BE, Marder EP, Min JY, Dunn JR, Smith RM, Dreyzehner J, Jones TF, Tennessee Fungal Meningitis Investigation Team. Fungal infections associated with contaminated methylprednisolone in Tennessee. N Engl J Med. 2012;367:2194–203. doi:10.1056/NEJMoa1212972.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. Gaspari R, Dayno M, Briones J, Blehar D. Comparison of computerized tomography and ultrasound for diagnosing soft tissue abscesses. Crit Ultrasound J. 2012;4(1):5. doi:10.1186/2036-7902-4-5.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev. 2000;23(4):175–204.

    Article  CAS  PubMed  Google Scholar 

  20. Pigrau C, Almirante B, Flores X, et al. Spontaneous pyogenic vertebral osteomyelitis and endocarditis: incidence, risk factors, and outcome. Am J Med. 2005;118:1287.

    Article  PubMed  Google Scholar 

  21. Zimmerli W. Clinical practice. Vertebral osteomyelitis. N Engl J Med. 2010;362:1022–9.

    Article  CAS  PubMed  Google Scholar 

  22. Palestro CJ, Love C, Miller TT. Infection and musculoskeletal conditions: imaging of musculoskeletal infections. Best Pract Res Clin Rheumatol. 2006;20:1197–218.

    Article  PubMed  Google Scholar 

  23. Nasto A, Colangelo D, Rossi B, Fantoni M, Pola E. Post-operative spondylodiscitis. Eur Rev Med Pharmacol Sci. 2012;16 Suppl 2:50–7.

    PubMed  Google Scholar 

  24. Rice I, Wee MY, Thomson K. Obstetric epidurals and chronic adhesive arachnoiditis. Br J Anaesth. 2004;92(1):109–20.

    Article  CAS  PubMed  Google Scholar 

  25. Morais-Almeida M, et al. Allergy to local anesthetics of the amide group with tolerance to procaine. Allergy. 2003;58:827–8.

    Article  CAS  PubMed  Google Scholar 

  26. Smuck M, et al. Incidence of simultaneous epidural and vascular injection during cervical transforaminal epidural injections. Spine. 2011;36:E220–3.

    Article  PubMed  Google Scholar 

  27. Danesh H, Sayanlar J. Interventional pain management. In: Sackheim K, editor. Rehabi clinical pocket guide, Rehabilitation medicine. New York: Springer; 2013. p. 427–65.

    Chapter  Google Scholar 

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Author information

Authors and Affiliations

  1. Manhattan Spine and Pain Medicine, SUNY Downstate Medical Center, Lenox Hill Hospital, New York, NY, USA

    Sudhir Diwan M.D., F.I.P.P., A.B.I.P.P.

  2. Beth Israel Medical Center, New York, NY, USA

    Rudy Malayil M.D.

  3. Department of Orthopedics, Hospital for Joint Disease at NYULMC, New York, NY, USA

    Staicey Mathew M.D.

Authors
  1. Sudhir Diwan M.D., F.I.P.P., A.B.I.P.P.
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  2. Rudy Malayil M.D.
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  3. Staicey Mathew M.D.
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Editor information

Editors and Affiliations

  1. Department of Rehabilitation Medicine, Interventional Pain Management, New York University , Langone Medical Center, New York, New York, USA

    Kimberly A. Sackheim

Appendix 1

Appendix 1

Post-procedure instructions (with permission from Danesh H, Sayanlar J. Interventional Pain Management. In: Sackheim K. Rehab Clinical Pocket Guide. Rehabilitation Medicine. Springer, New York, 2013: 427–465) [27]

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Diwan, S., Malayil, R., Mathew, S. (2015). Injection Complications and Management. In: Sackheim, K. (eds) Pain Management and Palliative Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2462-2_44

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  • DOI: https://doi.org/10.1007/978-1-4939-2462-2_44

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-2461-5

  • Online ISBN: 978-1-4939-2462-2

  • eBook Packages: MedicineMedicine (R0)

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