Open AccessImmediate and Acute Adverse Effects Following Transforaminal Epidural Steroid Injections with Dexamethasone
Author(s) -
Omar El
Publication year - 2015
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2015/18/277
Subject(s) - medicine , dexamethasone , adverse effect , anesthesia , epidural steroid injection , surgery , low back pain , alternative medicine , pathology
Background: Transforaminal epidural steroid injections (TFESI) are widely used for theconservative treatment of radicular pain. The use of dexamethasone in TFESIs is relatively new;therefore, immediate and acute adverse effects that it may cause are not fully updated.Objective: To evaluate immediate and acute adverse effects following TFESI with dexamethasone.Study Design: Prospective, observational study.Setting: A spine center affiliated with a rehabilitation hospital.Methods: One hundred fifty consecutive patients receiving TFESI for the management ofradicular and axial spinal pain at the cervical, lumbar, and sacral levels with dexamethasone usingfluoroscopic guidance with digital subtraction technology were enrolled. The occurrence of adverseeffects in patients in the 2-week time period following interventions was monitored through a setof questionnaires followed up by phone calls scheduled for 1 day, day 3, and day 14. Intensity andduration of side effects were recorded.Results: Of the 150 patients enrolled, 31 patients (19.5%) experienced adverse effects within thefirst 30 minutes following the intervention. The most common adverse effects were numbness andtingling in the limb, which developed in 19 patients (11.95%) followed by perineal pruritus thatoccurred in 7 cases (4.4%). Patients also reported experiencing adverse effects within the 3 daysfollowing intervention; most complained of headaches, insomnia, hiccups, flushing, and increasedradicular pain. No major complications were noted.Limitations: The sample size enrolled might be too small to perceive possible rare side effectsrelated to the procedure. The 2-week follow-up period is a limitation for evaluating late sideeffects.Conclusions: This study offers provision to interventionalists that TFESI with dexamethasonewhen performed by experienced hands and with proper technique has minor self-limited transientadverse effects that can be easily managed. Patients should be made aware of these adverseeffects and their management. Further larger studies are needed to validate the safe use ofdexamethasone and the safety of transforaminal epidural injections.Key words: Transforaminal epidural steroid injection, complications, dexamethasone