Flushing Following Interlaminar Lumbar Epidural Steroid Injection with Dexamethasone

Background: Epidural steroid injections are commonly used in managing radicular pain.Most complications related to epidural injections are minor and self-limited. Flushing isconsidered as one such minor side effect. Flushing has been studied using various steroidpreparations including methylprednisone, triamcinolone, and betamethasone but itsfrequency has never been studied using dexamethasone.Objective: This study evaluates the frequency of flushing associated with fluoroscopyguided lumbar epidural steroid injections using dexamethasone.Study Design: Retrospective cohort design study. Patients presenting with low back painwere evaluated and offered a fluoroscopically guided lumbar epidural steroid injection usingdexamethasone via an interlaminar approach as part of a conservative care treatment plan.Setting: University-based Pain Management Center.Intervention: All injections were performed consecutively over a 2-month period by onestaff member using 16 mg (4 mg/mL) of dexamethasone. A staff physician specifically askedeach participant about the presence of flushing following the procedure prior to dischargeon the day of injection and again on follow-up within 48 hours after the injections. Theanswers were documented as “YES” or “NO.”Results: A total of 150 participants received fluoroscopically guided interlaminar epiduralsteroid injection. All participants received 16 mg (4 mg/mL) of dexamethasone with 2 mLof 0.2% ropiviciane. Overall incidence of flushing was 42 out of 150 cases (28%). Of the42 participants who experienced flushing, 12 (28%) experienced the symptom prior todischarge following the procedure. Twenty-seven of the 42 (64%) were female (P < 0.05).All the participants who experienced flushing noted resolution by 48 hours. No other majorside effects or complications were noted.Limitations: Follow-up data were solely based on subjective reports by patients viatelecommunication. Follow-up time was limited to only 48 hours, which overlooks thepossibility that more participants might have noted flushing after the 48 hour limit.Conclusions: Flushing is commonly reported following epidural steroid injections. Withan incidence of 28%, injections using dexamethasone 16 mg by interlaminar epidural routeappear to be associated with more flushing reaction than previously reported with othersteroid preparations. Additionally, female participants are more likely to experience flushingthough the reactions seem to be self-limiting with resolution by 48 hours.Key words: flushing, side effects, epidural, back pain, lumbar, steroid, dexamethasone,injections.