• Title, Summary, Keyword: epidural injection

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Comparison of Transforaminal Epidural Steroid Injection and Lumbar/Caudal Epidural Steroid Injection for the Treatment of Lumbosacral Radiculopathy (요천추부 신경근병증의 치료를 위한 경추간공 경막외 스테로이드 주입과 요추 및 미추 경막외 스테로이드 주입의 비교)

  • Jung, Sun Sop;Lee, Won Hyung
    • The Korean Journal of Pain
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    • v.18 no.1
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    • pp.23-28
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    • 2005
  • Background: An epidural steroid injection (ESI) is usually used for the treatment of low back pain with radiculopathy. An ESI can be performed by two procedures: I) a lumbar or caudal epidural steroid injection and II) a transforaminal epidural steroid injection. Methods: Ninety-three patients, who had undergone transforaminal epidural steroid injection (Group II), and either a lumbar or caudal epidural steroid injection (Group I), were retrospectively studied. The authors assessed the pain, walking, standing improvement and side effects after each procedure, which were evaluated as being very good, good, fair or poor. Data were collected from the patients medical records and analyzed using the chi-squared test. P < 0.05 was considered significant. Results: There were no statistically significant differences in the pain, walking, standing improvement and side effects between the two groups. However, there was a statistically significant difference in the pain improvement following transforaminal epidural steroid injection in those not effectively responding to an initial lumbar or caudal epidural block in Group II. Conclusions: A transforaminal epidural steroid injection is a useful alternative to a lumbar or caudal epidural steroid injection for low back pain with radiculopathy.

Pneumocephalus after Epidural Steroid Injection -A case report- (경막외강 스테로이드 주입 시 발생한 기뇌증 -증례 보고-)

  • Jung, Sung-Kyu;Park, Kyung-Hee
    • The Korean Journal of Pain
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    • v.14 no.2
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    • pp.276-279
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    • 2001
  • Epidural steroid injection is one method of releiving chronic back pain. However, problems with the loss of resistance to air technique include the possible subarachnoid or subdural injection of air resulting in headache, venous air embolism, and the introduction of air bubbles into the epidural space. Pneumocephalus is a rare complication of epidural block for epidural steroid injection. We report a case of a 58-year-old woman who developed a severe headache and posterior nuchal pain with incomplete oculomotor palsy due to pneumocephalus occuring after an epidural steroid injection.

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Severe Respiratory Depression and Intracranial Air after Epidural Morphine -Subdural or Epidural Injection?- (경막외 Morphine 투여에 의한 극심한 호흡억제 및 두개강내 공기음영)

  • Kang, Mi-Gyeong;Moon, Dong-Eon;Suh, Jae-Hyun
    • The Korean Journal of Pain
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    • v.6 no.2
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    • pp.270-274
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    • 1993
  • Massive extradural spread, distinguished from subarachnoid injection that sometimes follows the introduction of small amounts of local anesthetics or narcotics during attempted epidural anesthesia or analgesia, has been attributed to subdural injection. A 64-year-old woman was admitted for partial radical hysterectomy under general anesthesia after insertion of lumbar epidural cathter by loss of resistance technique with 5 ml of air. In this case, we experienced severe respiratory depression and loss of consciousness after administration of 4 mg of morphine for postoperative pain control. We confirmed air shadows at right silvian and suprasella cisterna region by CT scanning. Patients was recovered without sequele after 2 days, As this case resembles a "massive epidural", it is suggested that subdural injection rather than epidural injection may explain the phenomenon.

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Hyperprolactinemia and Galactorrhea Following Single Epidural Steroid Injection (경막외강내 스테로이드 투여후 관찰된 혈중 Prolactin 증가와 유즙 분비 -증례 보고-)

  • Won, Seog-Kyu;Chun, Yong-Suk;Suk, Min-Ho;Shim, Jae-Chol
    • The Korean Journal of Pain
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    • v.11 no.1
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    • pp.150-154
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    • 1998
  • Epidural steroid injection have become one of the most frequently applied conservative option for the management of acute and chronic back pain. As the indications for epidural steroid injections increase so do the adverse responses associated with this procedure. This study reports the succession of 3 patients who developed galactorrhea and hyperprolactinemia after recieving an epidural steroid injection for lumbar radiculopathy and low back pain. Serum prolactin level was elevated in accordance with epidural injection of corticosteroid. We measured the serum prolactin level by immunoradiometric assay method and peak serum prolactin level at above 500, 144.2, 150.3 ng/ml respectively. Also we found the serum prolactin level decreased to normal values 3 wks after corticosteroid injection. Galactorrhra ceased in advance of decrease of serum prolactin level. That "Hyperprolactinemia and galactorrhea can occur following epidural steroid injection", requires a much larger prospective investigation.

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Delayed Pneumocephalus Following Fluoroscopy Guided Cervical Interlaminar Epidural Steroid Injection : A Rare Complication and Anatomical Considerations

  • Kim, Yeon-Dong;Ham, Hyang-Do;Moon, Hyun-Seog;Kim, Soo-Han
    • Journal of Korean Neurosurgical Society
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    • v.57 no.5
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    • pp.376-378
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    • 2015
  • Cervical epidural steroid injection is indicated for radicular symptoms with or without axial neck pain. Complications are rare but can be serious. Here, we report the case of a 54-year-old man with cervical radicular pain who was treated with cervical epidural steroid injection. Injection was administered twice under fluoroscopic guidance with the loss-of-resistance technique using air to confirm the epidural space. After the second procedure, the patient complained of severe persistent headache and was diagnosed with pneumocephalus on brain computed tomography. The patient returned home without any neurological complication, after a few days of conservative treatment. Though, a fluoroscopic guidance cervical epidural injection is also known to diminish the risk of complications. Physicians should always keep in mind that it does not guarantee safety, particularly in the cervical region, related to its anatomical considerations.

Accidental Subdural Injection during Attempted Cervical Epidural Block: Radiologic Evidence -A case report- (경추부 경막외 차단 중 발생한 경막하 주사의 영상 소견 -증례보고-)

  • Ko, Hyun Hak;Kim, Ji Soo;Lee, Jae Jun;Hwang, Sung Mi;Lim, So Young
    • The Korean Journal of Pain
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    • v.22 no.1
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    • pp.83-87
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    • 2009
  • Case reports after accidental subdural injection during attempted epidural block have usually described extensive neuraxial blocks with a characteristic radiographic appearance on contrast injection. We experienced a case of cervical subdural injection with unusual clinical findings and radiographic appearance. A 51-year-old female patient with central herniated nucleus pulposus at cervical (C5/6) and lumbar level (L4/5, L5/S1) was referred to the pain clinic. During attempted cervical epidural block at the C6/7 interspace with fluoroscopy, injection of the 4 ml contrast showed posterior spread at cervical level. After cervical epidural steroid injection, the contrast was also confined to the posterior aspect of the spinal canal at lumbar level with fluoroscopy. In order to discriminate subdural space from epidural space, we performed transforaminal epidural injection of the 2 ml contrast at the L5/S1 interspace and we could confirm cervical epidural injection was made into the subdural space. We discuss the clinical characteristics of a subdural injection and the appearance of the cervical and lumbar subdurogram.

Accuracy of Live Fluoroscopy to Detect Intravascular Injection During Lumbar Transforaminal Epidural Injections

  • Lee, Min-Hye;Yang, Kyung-Seung;Kim, Young-Hoon;Jung, Hyun-Do;Lim, Su-Jin;Moon, Dong-Eon
    • The Korean Journal of Pain
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    • v.23 no.1
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    • pp.18-23
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    • 2010
  • Background: Complications following lumbar transforaminal epidural injection are frequently related to inadvertent vascular injection of corticosteroids. Several methods have been proposed to reduce the risk of vascular injection. The generally accepted technique during epidural steroid injection is intermittent fluoroscopy. In fact, this technique may miss vascular uptake due to rapid washout. Because of the fleeting appearance of vascular contrast patterns, live fluoroscopy is recommended during contrast injection. However, when vascular contrast patterns are overlapped by expected epidural patterns, it is hard to distinguish them even on live fluoroscopy. Methods: During 87 lumbar transforaminal epidural injections, dynamic contrast flows were observed under live fluoroscopy with using digital subtraction enhancement. Two dynamic fluoroscopy fluoroscopic images were saved from each injection. These injections were performed by five physicians with experience independently. Accuracy of live fluoroscopy was determined by comparing the interpretation of the digital subtraction fluoroscopic images. Results: Using digital subtraction guidance with contrast confirmation, the twenty cases of intravascular injection were found (the rate of incidence was 23%). There was no significant difference in incidence of intravascular injections based either on gender or diagnosis. Only five cases of intravascular injections were predicted with either flash or aspiration of blood (sensitivity = 25%). Under live fluoroscopic guidance with contrast confirmation to predict intravascular injection, twelve cases were predicted (sensitivity = 60%). Conclusions: This finding demonstrate that digital subtraction fluoroscopic imaging is superior to blood aspiration or live fluoroscopy in detecting intravascular injections with lumbar transforaminal epidural injection.

Effect of Epidural Mortphine for Post-Thoracotomy Pain (개흉술후 경막외 몰핀에 의한 진통효과)

  • Yu, Ung-Cheol;Lee, Jeong-Eun;Im, Seung-Pyeong
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.26 no.4
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    • pp.303-307
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    • 1993
  • Postoperative pain relief and the side effects of epidurally injected morphine were investigated in 10 patients who received thoracotomy. Epidural morphine injection was given via an epidural catheter after thoracotomy. The pain score[VAS] and repiratory rate were decreased and the SaO2, tidal volume and vital capacity were increased significantly after epidural morphine injection. The analgesia of epidural morphine lasted for 13 hours with average. The side effects of epidural morphine were few and mild, but urinary retention was in 10%[1/10] of total patients.

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Management of Cervical Radiculopathy with Epidural Steroid Injection (경막외 스테로이드 주입에 의한 경부 신경근증의 치료)

  • Shin, Keun-Man;Hong, Soon-Yong;Choi, Young-Ryong
    • The Korean Journal of Pain
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    • v.4 no.2
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    • pp.147-151
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    • 1991
  • Cervical epidural steroid injection, although not as familiar to many anesthesiologists, can be useful in the management of patients with acute and chronic neck, shoulder and arm pain. My clinic personally contacted and interviewed thirty patients with cervical radiculopathy who received cervical epidural steroid injection. Twenty seven percent of the patients had a excellent response(greater than 75% improvement) and fifty percent of the patients had a good response (greater than 50% improvement) to an injection of steroid into the cervical epidural space. We have concluded that cervical epidural steroid injection was very effective in the management of cervical radiculopathy and represented a possible alternative to surgery. Many anesthesiologists should add to their armamentarium the use of such techniques in the management of cervical radiculopathy.

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Analysis of Influencing Factors to Depth of Epidural Space for Lumbar Transforaminal Epidural Block in Korean

  • Kim, Lee-Kyoung;Kim, Jung-Ryul;Shin, Sung-Sick;Kim, In-Ji;Kim, Bac-Ne;Hwang, Gan-Tac
    • The Korean Journal of Pain
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    • v.24 no.4
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    • pp.216-220
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    • 2011
  • Background: Transforaminal epidural steroid injection is one of the effective treatments in managing radicular pain. There have been some prospective studies on the depth to the epidural space with the transforaminal approach. However, there have been no studies about the depth in Asians, especially Koreans. This study was carried out in order to evaluate the depth to the epidural space and the oblique angle and factors that influence the depth to the epidural space during lumbar transforaminal epidural injection. Methods: A total of 248 patients undergoing fluoroscopically guided transforaminal epidural steroid injections were evaluated. At the L3-4, L4-5, L5-S1, and S1 levels, we measured the oblique angle and depth to the epidural space. Results: Needle depth was positively associated with body mass index (correlation coefficient 0.52, P = 0.004). The median depths (in centimeters) to the epidural space were 6.13 cm, 6.42 cm, and 7.13 cm for 50-60 kg, 60-70 kg, and 70-80 kg groups, respectively, at L5-S1. Age and height were not significantly associated with the needle depth. Conclusions: There is a positive association between the BMI (and weight) and transforaminal epidural depth but not with age, sex, and height.