Neil Osterwell of MedScape recently published an article entitled Panel Recommends Steps for Safer Epidural Injections. This this article, Osterwell states that while the risk of potentially catastrophic, neurological injuries from epidural steroid injections (ESIs) is rare, it can, and should be, reduced. Clinicians need merely follow specific safety measures as drawn up by a consensus panel representing thirteen national medical organizations.

The panelists, who represented a wide range of specialities, worked together to review all available evidence regarding neurologic injuries caused by epidural injections and the pulled together what they considered to be the best clinical considerations for reducing or eliminating these types of injuries. Their recommendations were published online on February 9, 2015 in Anesthesiology.

The Panelists’ 17 Recommendations

The panelists made 17 specific recommendations including, but not limited to:

• Practitioners must wear face masks and sterile gloves during the procedure
• All cervical and lumber interlaminar injections should be performed under image guidance
• Cervical interlaminar ESIs are recommended at vertebrae C7 to T1, but preferably not higher than the C6 to C7 level
• No cervical interlaminar ESIs should be performed at any segmental level without ensuring via imaging studies that there is adequate epidural space for placement of the needle
• The treating physician should make the ultimate choice between interlaminar or transforaminal techniques and this decision should be made by weighing potential risks and benefits with each technique for a given patient

More Research Is Needed

Osterwell points out that an accompanying editorial by Brian Thomas Bateman, MD, MSc, and Gary J. Brenner, MD, PhD, from the Department of Anesthesia, Critical Care and Pain Medicine at Massachusetts General Hospital in Boston, makes an argument for the need of further research into the causes and prevention of injuries associated with well-intentioned ESIs.

The authors of this editorial emphasize the need for better understanding of the factors that may contribute to risk for serious neurological injuries from ESI. These factors can include such things as patient-specific, technical, and pharmacologic considerations.

Learn more about this subject and get the full list of recommendations by reading the full Medscape article here.

Reference

Medscape Feb. 13, 2015
Anesthesiology, Feb. 9. 2015