Korean J Radiol.  2018 Apr;19(2):301-310. 10.3348/kjr.2018.19.2.301.

The Incidence of Various Types of Systemic Reactions Related to Epidural Steroid Injections: A Prospective Observational Study

• Lee GY
• Lee JW
• Yeom JS
• Kim KJ
• Shin HI
• Kang HS

• KMID: 2404927
• DOI: http://doi.org/10.3348/kjr.2018.19.2.301

Abstract

OBJECTIVE
To evaluate the incidence, types and association of systemic reactions after an epidural steroid injection (ESI) with patient demographics, ESI factors and repeated occurrence of an ESI.
MATERIALS AND METHODS
This prospective observational study was approved by the Institutional Review Board of our hospital, and written informed consent was obtained from all the participants. From October to December 2011, systemic reactions at 2 weeks after 960 ESIs among 885 patients were measured. Patients were evaluated by phone interviews to obtain the patients' demographics, history of previous ESI, ESI factors, and ESI reoccurrence. Statistical analyses were performed using the chi-square tests, Fisher's exact tests and a binary logistic regression analysis.
RESULTS
Overall, 557 types of systemic reactions occurred after 292 injections (30.4%) of a total of 960 ESIs in which facial flushing was most common (131/557, 23.5%) and 144 ESIs were followed by a mixed form of systemic reactions (49.3%). Age of 62 years or younger (odds ratio [OR], 2.361), female sex (OR, 1.674), and history of diabetes mellitus (OR, 1.681) were significant risk factors in the occurrence of systemic reactions after an ESI. In 73 patients with repeated ESI, 14 patients re-experienced systemic reactions (19.2%), of which twelve re-experienced the same systemic reaction as the previous one.
CONCLUSION
Systemic reactions followed about 30% of ESIs, and more commonly occurred in patients 62 years of age or younger, women, and diabetic patients. Half of the patients experienced a mixed form of systemic reactions. Patients with recurring systemic reactions tend to re-experience the same systemic reaction as the prior one after an ESI.

Keyword

Epidural; Steroid; Injection; Spine; Chronic pain; Treatment; Side effects; Systemic effects

MeSH Terms

Chronic Pain
Demography
Diabetes Mellitus
Ethics Committees, Research
Female
Flushing
Humans
Incidence*
Informed Consent
Logistic Models
Observational Study*
Prospective Studies*
Risk Factors
Spine

Figure

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  Fig. 1 Flowchart of inclusion and exclusion of patients.

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