Writing in the Online First edition of February’s Anesthesiology, a panel of experts from 13 national medical organizations have compiled suggestions aimed at preventing injuries and improving patient safety in the administration of epidural steroid injections. While commonly used to treat chronic pain, the procedure can, in rare situations, produce life-threatening neurological injuries such as stroke and paralysis. “…there has been little agreement among practitioners on how best to minimize risks of injury—until now,” said James Rathmell, MD, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston. “We reached a cross-specialty consensus of suggestions that, if followed, might reduce the risk of harm for patients.”
The 17 clinical considerations offered by the panel include discouraging the use of particulate vs nonparticulate steroids in certain situations. The recommendations also include guidance for technical aspects of the injections such as the provider’s use of a face mask and sterile gloves, review of the patient’s prior imaging studies, and avoiding heavy sedation. The panel additionally voiced the need for further studies of the risks and benefits of epidural procedures. A news story about the recommendations may be read here.