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Complications of Fluoroscopically Guided Caudal Epidural Injections

Botwin, Kenneth P. MD; Gruber, Robert D. DO; Bouchlas, Constantine G. MD; Torres-Ramos, Francisco M. MD; Hanna, Ashraf MD; Rittenberg, Joshua MD; Thomas, Santhosh A. DO

American Journal of Physical Medicine & Rehabilitation: June 2001 - Volume 80 - Issue 6 - p 416-424
Research Articles: Radiculopathy

Botwin KP, Gruber RD, Bouchlas CG, Torres-Ramos FM, Hanna A, Rittenberg J, Thomas SA: Complications of fluoroscopically guided caudal epidural injections. Am J Phys Med Rehabil 2001;80:416–424.

Objectives To assess the incidence of complications of fluoroscopically guided caudal epidural injections.

Design A retrospective cohort design study in which chart review was performed on patients, who presented with radiculopathy and received fluoroscopically guided caudal epidural steroid injections. All injections were performed consecutively over a 12-mo period. An independent observer reviewed medical charts, which included a 24-hr post procedure telephone call by an ambulatory surgery center nurse, who asked a standardized questionnaire about complications after the injections. Physician follow-up office notes 1 to 3 wk after injection along with epidurograms were reviewed.

Results The charts of 139 patients, who received 257 injections, were reviewed. Complications per injection included 12 episodes of insomnia the night of the injection (4.7%), 9 transient nonpositional headaches that resolved within 24 hr (3.5%), 8 increased back pain (3.1%), 6 facial flushing (2.3%), 2 vasovagal reactions (0.8%), 2 episodes of nausea (0.8%), and 1 increased leg pain (0.4%). No dural punctures occurred.

Conclusions No major complications occurred. The incidence of minor complications was 15.6% per injection. All reactions resolved without morbidity and no patient required hospitalization.

From the Florida Spine Institute, Clearwater, Florida.

All correspondence and requests for reprints should be addressed to Kenneth P. Botwin, MD, Florida Spine Institute, 2250 Drew Street, Clearwater, FL 33765.

© 2001 Lippincott Williams & Wilkins, Inc.