Epidural Complications and troubleshooting

Maria Teresa Bovaira-Forner MD , Javier de Andrés Ares MD , Gisela Roca MD , Maria Luisa Franco Gay MD , Consuelo Nieto MD , Paula Bovaira MD
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引用次数: 1

Abstract

Epidural corticosteroid infiltrations are an important option for the treatment of pain, though they are not without complications. The present review was based on a PubMed database search of articles covering the period between 1983 and 2014. The described complications can be grouped into the following categories: (1) Infections: The global risk of infections following epidural corticosteroid infiltration is 1%–2%, of which 0.1% prove serious. (2) Neurologic alterations: These complications are due to neurotoxicity (arachnoiditis or aseptic meningitis) or intra-arterial puncture and embolization of particulate corticosteroids in vertebral arteries, resulting in spinal or cerebral infarction. (3) Bleeding: The principal risk factor for epidural hematoma is primary or pharmacologic coagulopathy. Therefore, the decision to suspend treatment must be made according to the consensus-based clinical guides. (4) Post–dural puncture headache: The development of headache in these cases is less frequent than following epidural anesthesia. (5) Pharmacologic effects of corticosteroids: Adrenal axis suppression during 3 weeks may be observed. This has been associated with Cushing-like symptoms, mineralocorticoid effects (arterial hypertension), and blood glucose level elevation in diabetic patients. (6) Others: There have been reports of diminished bone mass in postmenopausal women and isolated cases of chorioretinopathy and Tachon syndrome. Epidural corticosteroid infiltration performed under radioscopic control and with contrast administration can minimize the risk of complications.

硬膜外并发症及排除
硬膜外皮质类固醇浸润是治疗疼痛的重要选择,尽管它们并非没有并发症。目前的综述是基于PubMed数据库对1983年至2014年期间的文章的搜索。所描述的并发症可分为以下几类:(1)感染:硬膜外皮质类固醇浸润后感染的全球风险为1%-2%,其中0.1%为严重感染。(2)神经系统改变:这些并发症是由于神经毒性(蛛网膜炎或无菌性脑膜炎)或椎动脉内穿刺和栓塞颗粒皮质类固醇,导致脊髓或脑梗死。(3)出血:硬膜外血肿的主要危险因素是原发凝血障碍或药理学凝血障碍。因此,暂停治疗的决定必须根据基于共识的临床指南做出。(4)硬膜穿刺后头痛:这些病例中出现头痛的频率低于硬膜外麻醉。(5)皮质类固醇的药理作用:在3周内可观察到肾上腺轴抑制。这与糖尿病患者的库欣样症状、矿化皮质激素效应(动脉性高血压)和血糖水平升高有关。(6)其他:有报道称绝经后妇女骨量减少,并有单独的脉络膜视网膜病变和Tachon综合征病例。硬膜外皮质类固醇浸润在放射镜下控制,并与造影剂可以减少并发症的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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