| Analgesics

Pain Procedure Contrast Agent Warning

Joint Practice Advisory: Brain Damage and Death

The journal Anesthesia & Analgesia has published a practice advisory developed with nearly all the United States pain societies. The American Society of Regional Anesthesia and Pain Medicine along with 10 other organizations warn against using gadolinium-based contrast agents (GBCAs), used off-label for patients who are intolerant to iodinated contrast medium. GBCAs have been used in interventional pain procedures, and if inadvertently administered into the intrathecal space has caused encephalopathy and even death.

Using gadolinium comes with risks: nephrogenic systemic fibrosis, gadolinium brain deposition/retention, and encephalopathy/death. The article states, "The use of GBCAs in the intrathecal and epidural spaces is not FDA-approved and if it is determined that a GBCA is needed based on a benefit/risk analysis, then the lowest volume and molar concentration of gadolinium should be utilized. Regardless of which gadolinium product is used, every precaution should be observed to avoid unintentional injection of the gadolinium into the intrathecal space."



Read the Practice Advisory.

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