Experts provide suggestions to prevent neurological injuries associated with epidural steroid injections

Epidural steroid injections are commonly used to treat pain; however, they can in rare situations produce life-threatening neurological injuries such as stroke and paralysis. In the Online First edition of February's Anesthesiology, the official medical journal of the American Society of Anesthesiologists® (ASA®), a panel of experts representing 13 national medical organizations provided 17 suggestions aimed at preventing such injuries and improving patient safety.

"Neurologic injury associated with epidural steroid injections has been recognized as a rare but serious complication for more than a decade, but there has been little agreement among practitioners on how best to minimize risks of injury - until now," said James Rathmell, M.D., 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 panel of experts from 13 medical organizations, including ASA, provided 17 clinical considerations, including discouraging the use of particulate versus 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. Panel meetings were facilitated by the U.S. Food and Drug Administration (FDA) Safe Use Initiative, which was created to promote public and private collaborations within the health care community aimed at improving safety.

An accompanying editorial supported the consensus document and provided additional forethought:

"While the [group's] consensus statement is an important step forward for pain medicine, it is essential that as a field we perform the studies that will better elucidate the risks of epidural steroid injection, to further refine the group's suggestions," said Brian T. Bateman, M.D., Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital. "Clinicians and patients need to be able to carefully consider the procedure's risks and benefits in deciding whether the balance of these factors is favorable given a patient's clinical condition, values, and preferences. A deeper understanding of the risks and benefits is urgently needed."