A complication during caudal steroid injection

Dere, Kamer; Akbaş, Mert; Biçerer, Enis; Özkan, Sezai; Dağlı, Güner

doi:10.3233/bmr-2009-0236

Cited by 5 publications

(2 citation statements)

References 12 publications

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“…Furthermore, caudal injections with or without steroids have been proven effective for pain relief and improvement of patients' functional status by a few prior studies [ 7 , 8 , 9 , 10 , 11 ]. Although caudal injection has generally been accepted as a safe procedure, major complications have been reported during and after caudal injections [ 12 , 13 , 14 ]. One of the critical complications following conventional caudal epidural injections is intravascular injection.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Two Techniques for Ultrasound-guided Caudal Injection: The Influence of the Depth of the Inserted Needle on Caudal Block

et al. 2015

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BackgroundCaudal epidural injections have been commonly performed in patients with low back pain and radiculopathy. Although caudal injection has generally been accepted as a safe procedure, serious complications such as inadvertent intravascular injection and dural puncture can occur. The present prospective study was designed to investigate the influence of the depth of the inserted needle on the success rate of caudal epidural blocks.MethodsA total of 49 adults scheduled to receive caudal epidural injections were randomly divided into 2 groups: Group 1 to receive the caudal injection through a conventional method, i.e., caudal injection after advancement of the needle 1 cm into the sacral canal (n = 25), and Group 2 to receive the injection through a new method, i.e., injection right after penetrating the sacrococcygeal ligament (n = 24). Ultrasound was used to identify the sacral hiatus and to achieve accurate needle placement according to the allocated groups. Contrast dyed fluoroscopy was obtained to evaluate the epidural spread of injected materials and to monitor the possible complications.ResultsThe success rates of the caudal injections were 68.0% in Group 1 and 95.8% in Group 2 (P = 0.023). The incidences of intravascular injections were 24.0% in Group 1 and 0% in Group 2 (P = 0.022). No intrathecal injection was found in either of the two groups.ConclusionsThe new caudal epidural injection technique tested in this study is a reliable alternative, with a higher success rate and lower risk of accidental intravascular injection than the conventional technique.

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Section: Discussionmentioning

confidence: 99%

A Comparison of Two Techniques for Ultrasound-guided Caudal Injection: The Influence of the Depth of the Inserted Needle on Caudal Block

et al. 2015

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“…Of these, only 16 were randomized trials (63,64,66,68,78,84,128,130,(135)(136)(137)(138)140,162,163,166,167,169) and 19 were non-randomized studies (46,47,57,67,73,79,129,132,134,144,152,154,155,158,159,164,168,170,171). The remaining 16 non-random-ized studies were performed without fluoroscopy (58,69,70,131,133,143,145,148,150,151,153,156,157,…”

Section: Outcome Of the Studiesmentioning

confidence: 99%

Caudal Epidural Injections in the Management of Chronic Low Back Pain: A Systematic Appraisal of the Literature

et al. 2012

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Background: Epidural injections with local anesthetics and steroids are one of the most commonly used interventions in managing chronic low back pain and lower extremity pain of various causes. However, despite their extensive use, debate continues on their effectiveness due to the lack of well-designed, randomized, controlled studies to determine the effectiveness of epidural injections in general, and caudal epidural injections in particular. Study Design: A systematic review of caudal epidural injections with or without steroids in managing chronic pain secondary to lumbar disc herniation or radiculitis, post lumbar laminectomy syndrome, spinal stenosis, and discogenic pain without disc herniation or radiculitis. Objective: To evaluate the effect of caudal epidural injections with or without steroids in managing various types of chronic low back pain with or without lower extremity pain emanating as a result of disc herniation or radiculitis, post lumbar laminectomy syndrome, spinal stenosis, and chronic discogenic pain. Methods: The available literature on caudal epidural injections with or without steroids in managing various types of chronic low back pain with or without lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for fluoroscopic observational studies. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to December 2011, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures of improvement in functional status, psychological status, return to work, and reduction in opioid intake were utilized. Results: For this systematic review, 73 studies were identified. Of these, 51 were excluded and a total of 16 studies met inclusion criteria for methodological quality assessment with 11 randomized trials and 5 nonrandomized studies. For lumbar disc herniation, the evidence is good for short- and long-term relief of chronic pain secondary to disc herniation or radiculitis with local anesthetic and steroids and fair relief with local anesthetic only. In managing chronic axial or discogenic pain, spinal stenosis, and post surgery syndrome, the indicated evidence is fair. Limitations: The limitations of this study include the paucity of literature, specifically for chronic pain without disc herniation. Conclusion: There was good evidence for short- and long-term relief of chronic pain secondary to disc herniation or radiculitis with local anesthetic and steroids and fair relief with local anesthetic only. Further, this systematic review also provided indicated evidence of fair for caudal epidural injections in managing chronic axial or discogenic pain, spinal stenosis, and post surgery syndrome. Key words: Chronic low back pain, lower extremity pain, lumbar disc herniation, lumbar radiculitis, lumbar discogenic pain, post lumbar laminectomy or surgery syndrome, spinal stenosis, caudal epidural injections, steroids, local anesthetic

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Injektionstherapie bei Zervikal- und Lumbalsyndromen: Grundlagen, Indikationen und allgemeine Durchführung

Grifka,

Götz,

Fenk-Mayer

et al. 2023

Orthopädie

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A complication during caudal steroid injection

Abstract: A careful real time fluoroscopic monitoring should be applied with the injection of opaque material to minimize the risk of vascular injection.

Cited by 5 publications

References 12 publications

A Comparison of Two Techniques for Ultrasound-guided Caudal Injection: The Influence of the Depth of the Inserted Needle on Caudal Block

A Comparison of Two Techniques for Ultrasound-guided Caudal Injection: The Influence of the Depth of the Inserted Needle on Caudal Block

Caudal Epidural Injections in the Management of Chronic Low Back Pain: A Systematic Appraisal of the Literature

Injektionstherapie bei Zervikal- und Lumbalsyndromen: Grundlagen, Indikationen und allgemeine Durchführung

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