Adverse events associated with fluoroscopically guided lumbosacral transforaminal epidural steroid injections.

Autor: Plastaras C; Department of PM&R, University of Pennsylvania, 1800 Lombard Street, Philadelphia, PA, 19146, USA., McCormick ZL; Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, McGaw Medical Center, Northwestern University Feinberg School of Medicine, 240 E. Huron St., Chicago, IL, 60611, USA. Electronic address: zmccormi@gmail.com., Garvan C; College of Nursing, University of Florida, 1225 Center Drive Gainesville, FL 32610, USA., Macron D; Department of Neurological Surgery, Stony Brook Neurosciences Institute, 24 Research Way, Suite 200, East Setauket, NY 11733, USA., Joshi A; Department of Orthopaedics, Duke University Medical Center, 200 Trent Dr, Durham, NC 27710, USA., Chimes G; Lake Washington Sports and Spine, 1600 116th Avenue Northeast #206, Bellevue, WA 98004, USA., Smeal W; Alegent Health Physical Medicine and Rehabilitation Clinic, 17021 Lakeside Hills Plaza Omaha, NE 68130, USA., Rittenberg J; Department of Physical Medicine and Rehabilitation, Kaiser Permanente, 3701 Broadway, 5th floor, Oakland, CA 94611, USA., Kennedy DJ; Department of Orthopaedics, Stanford University, 450 Broadway Street Pavilion C, 4th Floor Redwood City, CA 94063, USA.
Jazyk: angličtina
Zdroj: The spine journal : official journal of the North American Spine Society [Spine J] 2015 Oct 01; Vol. 15 (10), pp. 2157-65. Date of Electronic Publication: 2015 Jun 09.
DOI: 10.1016/j.spinee.2015.05.034
Abstrakt: Background Context: Although the types and incidence of adverse events (AEs) associated with transforaminal epidural steroid injection (TFESI) have been described, no study has used a systematic standardized questionnaire to solicit AEs from patients to capture an accurate range and incidence of complications.
Purpose: The aim was to systematically identify the types and incidence of AEs associated with TFESI. Additionally, this study evaluated demographic and clinical factors that may predict a higher risk of an AE.
Study Design/setting: This was a retrospective cohort study from a multiphysician academic PM&R clinic.
Patient Sample: Patients, aged 19 to 89, who underwent a fluoroscopically guided TFESI for lumbosacral radicular pain between 2004 and 2007 were included.
Outcome Measures: The relationship of AEs with gender, age, trainee presence, steroid type, preprocedure visual analog scale (VAS) pain score, systolic blood pressure, fluoroscopy time, and corticosteroid injectate volume was analyzed.
Methods: Adverse event data were collected using a survey both immediately and at 24 to 72 hours after TFESI. Statistical analysis was performed using the chi-square, Fisher exact, or Wilcoxon rank sum two-sided tests. Logistic regression analysis was also performed. C.P. is the owner of Rehabilitation Institute of Chicago Physiatric Log & Analysis System computer software.
Results: In 1,295 consecutive patients undergoing 2,025 TFESI procedures, immediate AEs and delayed AEs occurred after 182 (9.2%) and 305 (20.0%) injections, respectively. The most common immediate AEs were: vasovagal reaction (4.2%) and interrupted procedure from intravascular flow (1.7%). Common delayed AEs included: pain exacerbation (5.0%), injection site soreness (3.9%), headache (3.9%), facial flushing/sweating (1.8%), and insomnia (1.6%). Significant associations were identified between AEs and gender, age, preprocedure VAS, steroid type, and fluoroscopy time. Trainee involvement in the procedure did not impact the complication rate.
Conclusions: Fluoroscopically guided lumbosacral TFESI is associated with a similar rate of minor AEs both immediately and 24 to 72 hours after procedure that are typical of other axial corticosteroid injections. Permanent AEs were not found in this sample. The most common AEs associated with TFESI include vasovagal episodes, procedure interruption from intravascular flow, pain exacerbation, injection site soreness, headache, and insomnia.
(Copyright © 2015 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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