Korean J Pain.  2019 Jul;32(3):178-186. 10.3344/kjp.2019.32.3.178.

Systemic effects of fluoroscopically guided epidural steroid injection with dexamethasone

• Kang WY
• Lee JW
• Lee E
• Kang Y
• Ahn JM
• Kang HS

• KMID: 2455613
• DOI: http://doi.org/10.3344/kjp.2019.32.3.178

Abstract

BACKGROUND
Epidural steroid injections (ESIs) have been widely used in managing spinal pain. Dexamethasone has recently emerged as a useful drug in this setting, relative to particulate steroids, although the associated systemic effects have not been fully elucidated. This study aimed to investigate the incidences and types of systemic effects after fluoroscopically guided ESI with dexamethasone.
METHODS
This retrospective study included 888 ESIs with dexamethasone (fluoroscopically guided at the cervical and lumbosacral levels) performed on 825 patients during January to June 2017. Data regarding systemic effects were collected via telephone interviews using a standardized questionnaire at 2 weeks after the procedure. Data on patient demographic, clinical, and procedural characteristics were collected and analyzed to identify factors that were associated with systemic effects. All statistical analyses were performed using the chi-squared test.
RESULTS
Among the 825 patients, 40 patients (4.8%) experienced systemic effects during the 2-week follow-up period. The most common systemic effect was facial flushing (12 patients, 1.5%), which was followed by urticaria (7 patients, 0.8%) and insomnia (7 patients, 0.8%). A history of spine surgery was significantly associated with the occurrence of systemic effects (P = 0.036). Systemic effects were significantly more common for injections at the cervical level than at the lumbar level (P = 0.019).
CONCLUSIONS
Approximately 4.8% of the patients who underwent ESI with dexamethasone experienced minor and transient systemic effects. These effects were more common in patients who had undergone a previous spine surgery or received a cervical ESI.

Keyword

Complications; Dexamethasone; Drug-Related Side Effects and Adverse Reactions; Epidural Space; Fluoroscopy; Incidence; Low Back Pain; Steroids

MeSH Terms

Dexamethasone*
Drug-Related Side Effects and Adverse Reactions
Epidural Space
Fluoroscopy
Flushing
Follow-Up Studies
Humans
Incidence
Interviews as Topic
Low Back Pain
Retrospective Studies
Sleep Initiation and Maintenance Disorders
Spine
Steroids
Urticaria
Dexamethasone
Steroids