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At least 19 recordsLinked to original sources
PubMed2001

Persistent hiccup associated with thoracic epidural injection.

Epidural steroid injections are commonly used to treat lumbosacral radicular and discogenic pain. When used in this manner, these agents can cause minor, transient systemic side effects and rarely result in any serious complications. Because adverse reactions are uncommon and transient, epidural injections are considered a safe therapeutic intervention. We describe the first case of persistent hiccups as a consequence of a thoracic epidural steroid injection in a patient with thoracic discogenic pain.

Adult↗
PubMed1991

Percutaneous procedures for the diagnosis and treatment of lower back pain: diskography, facet-joint injection, and epidural injection.

This review discusses the indications, techniques, complications, and results of three percutaneous procedures used to evaluate and treat lower back pain: diskography, facet-joint injection, and epidural injection. Diskography, performed by injection of contrast medium into the nucleus pulposus, is a technique used to determine the cause of lower back pain in patients in whom findings on other imaging studies are normal or conflicting. Injection of steroids and anesthetic into the facet joints of the lumbar spine is useful to diagnose or treat patients with facet syndrome (back pain caused by abnormalities of the facet joints). Injection of steroids and anesthetic agents into the epidural space provides short-term relief, and can sometimes provide permanent relief, of lower back pain.

Anesthesia, Spinal↗
PubMed2000

Image-guided epidural injections.

Epidural steroid injection is a safe outpatient procedure, which is performed best using image guidance in conjunction with epidurography. Using the techniques described earlier, complications are minimized, and serious complications can be avoided, in experienced hands. The author has performed several thousand procedures in an outpatient setting without any serious complications. Optimal safety and efficacy require an excellent working knowledge of the radiographic anatomy, and the imaging equipment used to perform these procedures. Several studies have demonstrated the difficulty and uncertainty of obtaining an accurate injection without imaging guidance. Radiologists who are well trained in the performance of image-guided percutaneous injection procedures are thus armed with the background to perform these procedures in a safe and efficacious manner. In addition, referral of these procedures to a third party (radiologist) without economic incentives reduces the potential abuse of self-referral--which may occur (or be suspected by payors) when the primary clinician recommends, and then performs, pain management procedures. The use of sedation to perform these procedures is unnecessary, and deep sedation may be dangerous when injections are performed in the vicinity of the spinal cord. The author's experience, which includes clinical feedback and formal trials, shows the technique described in this article to be performed safely without sedation in an outpatient setting, with a high success rate for alleviating pain symptoms. When properly performed, epidural steroid injections have a clinically established role in the management of neck and back pain.

Anesthetics, Local↗
PubMed1984

Common bile duct pressure in dogs after opiate injection--epidural versus intravenous route.

The effect on the common bile duct pressure of epidurally injected morphine and fentanyl, was compared with that of intravenous injections of the same drugs in 12 mongrel dogs. Intravenous injection of morphine (0.1 mg X kg-1) or fentanyl (0.01 mg X kg-1) significantly elevated the common bile duct pressure from 10.48 +/- 0.37 to 21.68 +/- 0.33 cm H2O and from 9.66 +/- 0.33 to 14.14 +/- 0.21 cm H2O respectively. These increases occurred within 4-15 minutes after injection and lasted for about 2-3 hours. When the narcotics in identical dosages were injected epidurally, the common bile duct pressures were unchanged during the four hours of investigation. Further studies are planned to determine whether this beneficial effect of epidural narcotics applies also in the human clinical situation.

Animals↗
PubMed2003

Distant skip level discitis and vertebral osteomyelitis after caudal epidural injection: a case report of a rare complication of epidural injections.

STUDY DESIGN: A case report of distant discitis and vertebral osteomyelitis involving skip levels after caudal epidural steroid injection. OBJECTIVES: To report and investigate the occurrence of distant infective discitis and vertebral osteomyelitis involving skip levels after epidural injection. SUMMARY OF THE BACKGROUND DATA: Distant discitis and vertebral osteomyelitis is a serious but rare complication after epidural injection. A case involving skip levels and without the occurrence of epidural abscess formation has apparently not been previously reported in the literature. METHODS: An elderly woman presenting with clinical, radiologic, and magnetic resonance imaging evidence of spinal canal stenosis involving L3/4 and L4/5 levels and degenerative spondylolisthesis of the L4/5 level was given an epidural injection of steroids and lignocaine via the caudal route. A month later, she presented with worsened low back pain, elevated serum acute phase reactants, and plain radiographic evidence of L4/5 infective discitis. Magnetic resonance imaging and microbiologic examination of computed tomographically guided biopsy specimens confirmed infective discitis involving L2/3 and L4/5 intervertebral levels, together with adjacent vertebral osteomyelitis. RESULTS: The patient was successfully treated with antibiotics targeted at Pseudomonas aeruginosa, which was isolated in the culture of the biopsy specimens. Follow-up improvements in the clinical condition, serum acute phase reactants levels, radiographs, and magnetic resonance imaging were noted. CONCLUSIONS: Distant discitis and vertebral osteomyelitis involving skip levels and without the occurrence of epidural abscess formation is a serious but rare complication after epidural injection.

Aged↗
PubMed1987

Collagenase chemonucleolysis via epidural injection. A review of 252 cases.

Since 1975, collagenase has been injected into 252 herniated intervertebral discs for treatment of sciatica. Highly purified preparations of Chinese collagenase were extracted from Clostridium histolyticum CH 1093 in lyophylized form, which had a specific collagenolytic activity. It had a wide margin of safety as proven by repeated experiments in dogs by means of intradiscal, extradural, intradural, and intravenous injections. One hundred to two hundred units of collagenase dissolved in 5 ml of normal saline was injected epidurally in front of the line joining posterior vertebral body margins. The basic assumption is that the injected enzyme digested the nucleus pulposis. Symptoms disappeared or improved gradually within three to eight weeks. The total success rate was about 77%. For recurrent cases of those with less than satisfactory results, reinjections were performed without any visible antigenic reactions or neurologically adverse effects.

Adult↗
PubMed2002

[Morphofunctional changes in the spinal cord and spinal ganglion tissues following epidural injection of clopheline].

Epidural injection of clophelin extends the possibilities and increases of the effectiveness of regional anesthesia in clinical treatment of pain syndromes. Morphological and histoenzymological changes in spinal cord and spinal ganglion neurons were analyzed in dogs after epidural injection of clophelin. The results indicate the absence of pathological structural and metabolic changes in nervous tissue following clophelin administration. Increase in neuronal RNA content and microvascular alkaline phosphatase activity in experimental group as compared to the control one indicates the activation of protein synthesis and the augmentation of active transport processes in the nervous tissue capillary endothelium, both of which may be interpreted as the favorable phenomena.

Analgesics↗
PubMedDate not supplied

Severe lumbar back pain following epidural injection of local anesthetic for epidural anesthesia. Case report and literature review.

BACKGROUND AND OBJECTIVES: An epidural anesthetic was planned for a 75-year-old man scheduled for elective femoral-popliteal bypass grafting. METHODS: Severe and persistent back pain and posterior thigh muscle spasm abruptly began 10 minutes after epidural injection of mepivacaine. RESULTS: Signs of impending or evolving neurologic injury completely resolved shortly thereafter. CONCLUSIONS: The worst case scenarios, epidural hematoma and unintentional epidural injection of an irritant, are discussed along with other differential diagnoses. The literature is reviewed to gain insight into this unusual clinical presentation.

Aged↗
PubMedDate not supplied

Effects of epidural injection on spinal block during combined spinal and epidural anesthesia for cesarean delivery.

BACKGROUND AND OBJECTIVES: Epidural injection has been known to enhance spinal anesthesia in combined spinal and epidural (CSE) anesthesia. Saline and local anesthetics have been reported to have a volume effect, elevating sensory level when supplementing a volume into the epidural space. We evaluated the effects of epidural injection when using the CSE technique for cesarean delivery. METHODS: Sixty-six parturients were allocated randomly into group C (control, n = 21), S (saline, n = 21), or B (bupivacaine, n = 24): epidural injections of 10 mL saline and 0.25% bupivacaine were given in groups S and B, respectively, 10 minutes after they received 8 mg of 0.5% hyperbaric bupivacaine intrathecally, and no injection was given in group C. The sensory level at 10 minutes, the maximal level and the time to reach it, and degree of motor block and muscle relaxation were compared. We also investigated intraoperative side effects and postoperative findings in the postanesthesia care unit. RESULTS: Epidural injection raised the sensory level significantly in groups S and B, but the maximal height of sensory block and degree of muscle relaxation did not differ among the groups. Fewer patients complained of intraoperative pain in group B than in the other groups (P <.001). CONCLUSIONS: We could not achieve satisfactory surgical analgesia with 8 mg of hyperbaric bupivacaine injected into the subarachnoid space using the needle-through-needle technique in cesarean deliveries. An epidural saline injection elevated the sensory level, which did not improve the spinal block, whereas an epidural injection of 10 mL of 0.25% bupivacaine enhanced the spinal block and sustained the block postoperatively.

Adult↗
PubMed2005

Anatomy of the cervical intervertebral foramina: vulnerable arteries and ischemic neurologic injuries after transforaminal epidural injections.

Cervical transforaminal epidural steroid injections are performed for the treatment of radicular pain. Multiple recent case reports have raised safety concerns regarding neurologic deficits such as anterior spinal artery syndrome and cerebellar injury after these injections. To investigate the potential causes of these injuries, an anatomic study was conducted. In this study of 10 embalmed cadavers, the cervical intervertebral foramina were examined to determine if the ascending or deep cervical arteries supplied radicular or segmental medullary arteries potentially susceptible to cannulation or needle trauma during transforaminal injection. In two specimens, dissection was carried down to the spinal cord, demonstrating the anterior spinal, radicular, and segmental medullary arteries. Of 95 intervertebral foramina dissected, 21 had an arterial vessel proximal to the posterior aspect of the foraminal opening. Seven of these 21 were spinal branches that entered the foramen posteriorly, potentially forming radicular or segmental medullary vessels to the spinal cord. One additional ascending cervical artery formed a segmental medullary artery that joined the anterior spinal artery. This would only be injured by anterior needle misplacement. Of the seven foraminal branches, three were included in the deep dissections. Two contributed to segmental medullary arteries and one to a radicular artery. Variable anastomoses between the vertebral and cervical arteries were found. Therefore, it is possible to introduce steroid particles into the vertebral circulation via the cervical arteries. Critical arteries are located in the posterior aspect of the intervertebral foramen and may be vulnerable to injection or injury during transforaminal epidural steroid injection.

Aged↗
PubMed1996

[The level of analgesia with epidural injection of 2% mepivacaine using combined spinal and epidural analgesia].

We studied the level of analgesia obtained with epidural injection of 2% mepivacaine using combined spinal and epidural analgesia (CSE) and compared with the level obtained by epidural analgesia (EA). We inserted a catheter into the epidural space through the L2/3 interspace, and hyperbaric tetracaine was injected through the L3/4 interspace with 26G spinal needle in thirty patients for CSE. We checked the the level of analgesia 90 min after spinal anesthesia. After this, 23 out of 30 patients showed the extension of analgesia 15 min after injection of mepivacaine into the epidural catheter. In these patients, the level of analgesia and the dose of mepivacaine showed the regression line Y = 10.2-0.4X (Y: the level of analgesia, X: the dose of 2% mepivacaine, P < 0.05). We also showed the regression line Y = 16.1-0.7X (P < 0.05) for EA 15 min after epidural injection of mepivacaine in other 23 patients. To achieve the same level of analgesia of Th8 or Th6 with CSE and EA, the doses for epidural injection were calculated as 5.5 ml, 10.5 ml with CSE and 11.5 ml, 14.4 ml with EA, respectively. These results show that the epidural dose of local anesthetic for CSE is 1/2 to 2/3 of that necessary for EA.

Adult↗
PubMedDate not supplied

Predicting outcomes of transforaminal epidural injections for sciatica.

BACKGROUND CONTEXT: Previous studies on epidural injections have focused on efficacy and have not evaluated factors predicting outcomes of epidural injections. PURPOSE: To determine which patient factors are associated with transforaminal epidural injection outcomes for sciatica. STUDY DESIGN: Cross-sectional study design at a university spine center. PATIENT SAMPLE: Consecutive patients with sciatica who have had an electromyography study and a transforaminal epidural injection between January 1999 and July 2001. OUTCOME VARIABLE: The outcome variable was a composite score of the patients' pain severity and medication use compared with their initial visit. Independent variables included demographics, previous back surgery, pain severity at initial presentation, pain medication use at initial presentation, litigation, having Social Security Disability Insurance (SSDI) or workers' compensation, electromyography results. METHODS: Medical information was gathered on the variables listed above. RESULTS: Seventy-six patients, mean age 50.4 years and 49% female, participated. At a mean follow-up of 122 days (SD 146.3), 35 (47%) were improved, 21 (28% were unchanged) and 12 (16%) were worse. Initial correlation analysis showed some relationship between outcomes and having SSDI or workers' compensation (R=.43, p<.001), lifting requirements at work (R=.44, p=.002), working status (R=-.31, p=.02), and electromyogram evidence of radiculopathy (R=-.25, p=.04). Regression analysis showed that having SSDI or workers' compensation was the primary factor associated with worse outcomes. CONCLUSIONS: When controlled for SSDI/workers' compensation, lifting requirements at work, but not working status and radiculopathy, also were associated with outcomes but the association was not as strong. This paper brings into question the utility of offering epidural injections to patients who are on SSDI/workers' compensation and require heavy lifting at work.

Adult↗
PubMed1991

[Accidental epidural injection of hypertonic sodium chloride solution].

Twenty ml of 20% hypertonic saline were accidentally injected into the epidural space of a 53-year-old man with lumbar backache and sciatica. This resulted in severe thoracolumbar pain, which disappeared after he received by the same route 20 ml of 1% lidocaine and 40 ml distilled water. Three months later, the sciatica had almost all disappeared; there remained no motor deficit. A literature survey helped to explain the signs described. Further cases of accidental epidural injections of other drugs are discussed.

Humans↗
PubMed1999

Comparison of xylazine and lidocaine effects for analgesia and cardiopulmonary functions following lumbosacral epidural injection in goats.

The present study was carried out in order to compare the effects of xylazine and lidocaine on analgesia and cardiopulmonary parameters following epidural injection in goats. Twelve healthy Small East African goats of both sexes (mean +/- SD; 15.6 +/- 1.9 kg body weight) were used. The goats were randomly assigned to two groups of five and seven animals. The first group (n = 5) was given 2% lidocaine-HCl at 4400 micrograms/kg body weight. The second group (n = 7) was administered 2% xylazine-HCl at 150 micrograms/kg body weight. All drugs were diluted in 5 ml of sterile water and were injected epidurally through the lumbosacral interspace with the injection taking over 20 s. Both drugs induced analgesia within 5 min. Signs of sedation, cardiopulmonary changes and lateral recumbency developed within 5-7 min after administration of epidural xylazine. Tail flaccidity and hind limb paralysis developed 3 min after epidural administration of lidocaine. The time from recumbency to regaining normal stance was 60 and 158 min for xylazine- and lidocaine-treated animals respectively. Xylazine induced adequate analgesia of the flank and perineum, which extended to the head and forelimbs. In contrast, lidocaine induced adequate bilateral flank and perineal analgesia extending up to the third thoracic vertebra. For both drugs, analgesia of the flank and perineum persisted for the entire 180-min observational period. Epidural injection of xylazine and lidocaine caused variable depression effects on the cardiopulmonary values but was not so low as to cause concern. It is concluded that lumbosacral epidural injection of xylazine at 150 micrograms/kg body weight in 5 ml of water for injection offers the most desirable sedation and analgesia of the flank and perineum. The longer duration of analgesia may be useful for postoperative analgesia and relief of continuous straining in goats.

Adrenergic alpha-Agonists↗
PubMedDate not supplied

CT fluoroscopy-guided epidural injections: technique and results.

Lumbar epidural injections are typically performed blindly or with fluoroscopic guidance. CT fluoroscopy (CTF) can be used to guide needle placement precisely and rapidly, allowing visualization of the optimal needle path and identifying potential problems such as severe stenosis and synovial cysts before needle insertion. Operator and patient radiation dose is minimal when using the intermittent CTF technique and low mAs. By using this technique, just more than 2000 epidural steroid injections have been performed with no major complications. CTF is a useful guidance tool when performing lumbar epidural injections.

Fluoroscopy↗
PubMed2006

Inadvertent epidural injection of ondansetron.

A case of accidental epidural injection of ondansetron in a parturient is reported. No neurologic sequela resulted from the mistaken epidural injection. Vigilance is essential for minimizing the risk of epidural injections.

Adult↗
PubMed2000

Reinforcement of spinal anesthesia by epidural injection of saline: a comparison of hyperbaric and isobaric tetracaine.

PURPOSE: An epidural injection of saline was reported to extend spinal anesthesia because of a volume effect. The aim of this study was to evaluate the influence of the baricity of spinal local anesthetics upon the extension of spinal anesthesia by epidural injection of saline. METHODS: Forty patients undergoing elective lower-limb surgery were randomly allocated to four groups of 10 patients each. Group A received no epidural injection after the spinal administration of hyperbaric tetracaine (dissolved in 10% glucose). Group B received an epidural injection of 8 ml of physiological saline 20 min after spinal hyperbaric tetracaine. Group C received no epidural injection after spinal isobaric tetracaine (dissolved in physiological saline). Group D received an epidural injection of 8 ml of saline 20 min after spinal isobaric tetracaine. The level of analgesia was examined by the pinprick method at 5-min intervals. RESULTS: The levels of analgesia 20 min after spinal anesthesia were significantly higher in hyperbaric groups than in isobaric groups [T5 (T2-L2) vs. T7 (T3-12)]. After epidural injection of saline, the levels of analgesia in groups B and D were significantly higher than in groups A and C. The segmental increases after epidural saline injection were 2 (0-3) in group B and 2 (1-7) in group D. Sensation in the sacral area remained 20 min after spinal block in one patient in group D; however, it disappeared after epidural saline injection. CONCLUSION: In this study, 8 ml of epidural saline extended spinal analgesia. However, there was no difference between the augmenting effect in isobaric and hyperbaric spinal anesthesia. We conclude that the reinforcement of spinal anesthesia by epidural injection of saline is not affected by the baricity of the spinal anesthetic solution used.

Clinical Trial↗
PubMed2004

Epidurography contrast patterns with fluoroscopic guided lumbar transforaminal epidural injections:a prospective evaluation.

BACKGROUND: Lumbar transforaminal epidural injections have been utilized in the treatment of radicular pain with proven success. It was postulated that interlaminar epidural injections result in a dorsal flow of contrast while transforaminal epidural steroid injections showed good ventral flow limited to one single spinal motion segment. There have been no published studies evaluating epidurography/contrast patterns utilizing fluoroscopy. OBJECTIVE: To evaluate the pattern and spread of epidural contrast during fluoroscopically guided lumbar transforaminal epidural steroid injections. DESIGN: A prospective study of case series of 20 consecutive patients receiving lumbar transforaminal epidural injections. METHODS: Patients had either herniated nucleus pulposus or lumbar spinal stenosis. All patients received their injection by one of five physicians trained in this technique. Once the needle tip was felt to be in the anterior epidural space anteroposterior and a lateral radiographs were obtained after a total of 2 mL of iopamidol (Isovue) contrast was injected. Epidurograms were reviewed by a physician trained in fluoroscopic injections. Patterns were recorded as unilateral, bilateral, dorsal or ventral. Ventral flow, both cephalad and caudal, and number of lumbar intervertebral levels of flow were recorded as well. RESULTS: Ventral contrast flow occurred in all 20 injections. Unilateral contrast flow was noted in all injections. The mean number of levels of flow of contrast cephalad and caudad from the injection site were 1.13 and 0.6 levels, respectively, but these differences were not statistically significant. There were no significant differences in contrast flow noted between patients with herniated nucleus pulposus or lumbar spinal stenosis. Vascular injection patterns were noted with 2 injections, which required repositioning of the needles. CONCLUSION: Contrast appeared ventrally and unilaterally in all injections. Dorsal flow occurred in 20% of these injections. No contrast flow crossed the midline. The observed contrast flow patterns should be studied clinically to determine whether they have any effect on clinical outcome. Intravascular injections were noted in 10% of cases.

Journal Article↗