Document Type
Article
Publication Date
9-1-2021
Abstract
BACKGROUND: The American Society of Regional Anesthesia currently recommends ceasing antithrombotic medications for all spinal epidural steroid injections, however there is a paucity of data on the true risk of spinal epidurals via various approaches versus the risk of cessation of an agent as it relates to the underlying medical condition.
OBJECTIVE: This study evaluated the complication rate of caudal epidural steroid injections in patients who remain on antithrombotic medications.
STUDY DESIGN: Retrospective chart review.
SETTING: Physiatric Spine Clinic in Orthopedic Specialty Office and Surgical Center.
METHODS: A retrospective chart review was performed identifying patients (n = 335) who received a caudal epidural steroid injection (n = 673) from June 2015 through April 2020. Patients were included if they had received the injection while taking an antithrombotic medication. Patients were excluded if they were not taking an antithrombotic. The patient's age, indication for the injection including magnetic resonance imaging or computed tomography findings, antithrombotic medication, the medical condition requiring an antithrombotic, and any complications following the injection were collected via chart review.
RESULTS: Of the 443 injections included in the study, 51 encounters were lost to follow-up. Of the other 392 injections, there were no reported complications, regardless of the patient's imaging findings, age, the antithrombotic medication used, or the underlying medical condition for which an antithrombotic medication was indicated.
LIMITATIONS: This is a retrospective study. Therefore, a prospective study may have yielded fewer encounters lost to follow-up. Patients were not contacted directly after the procedure and chart reviews were utilized to evaluate for complications, which was limited to a patient's reporting of perceived complications without any imaging.
CONCLUSIONS: We conclude that caudal epidural steroid injections can be performed safely in patients while taking antithrombotic medications. Catastrophic events have been observed in patients who have discontinued antithrombotic agents preceding procedures. Thus, discontinuing antithrombotic medications may pose a greater risk than benefit for patients on an antithrombotic medication who have painful lumbar radiculopathy.
Recommended Citation
Simon, Jeremy I; Gehret, Jeffrey; Larsen, Eric S; Hummerston, DO, Kyle; Koehler III, DO, Philip J.; and Kitei, MD, Paul, "Caudal Epidural Steroid Injections in the Setting of Remaining on Antithrombotics: A Retrospective Study." (2021). Rothman Institute Faculty Papers. Paper 149.
https://jdc.jefferson.edu/rothman_institute/149
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License
Language
English
Comments
This article is the author's final published version in Pain Physician, Volume 24, Issue 6, September 2021, Pages E821 - E828.
The published version is available at https://doi.org/10.36076/ppj.2021.24.e821
Copyright © 2021, American Society of Interventional Pain Physicians. All rights reserved.
Open Access Statement: Pain Physician journal is committed to real and immediate open access for academic work. We operate under a Creative Commons license (CC-BY-NC). All of Pain Physician manuscripts are free to access immediately from the date of publication. There is no charge for any reader to download manuscripts for their own scholarly use. Readers can read, download, copy, distribute, print, search, or link to the full texts of the articles and reviews, or use them for any other lawful non-commercial purpose. Do not share the article/review if you have made changes to its content. Prior permission from the publisher or the author is not required but you must credit the author and link to the original site of publication.