Fact Finders for Patient Safety: Routine Intravenous Access for Epidural Steroid Injections Without Sedation

Fact: The published evidence does not support the rationale for routine placement of intravenous access prior to epidural steroid injections. For serious adverse events, such as spinal cord injury or stroke, intravenous access is irrelevant to management. For rare adverse events, such as seizure, anaphylaxis, or arrhythmia, intramuscular administration of therapeutic medications is no less effective than intravenous administration. More common adverse effects, such as symptomatic hypertension and vasovagal reaction, are not improved by immediate intravenous treatment.