Researchers urge cautious use of steroid injections to treat pain – mahrgan

Author: Pat Anson, PNN editor

New research warns that patients who receive epidural anesthesia or multiple injections of high-dose epidural anesthesia in the buttocks during childbirth will have rare but serious long-term complications. Doctors and patients use corticosteroid injections to relieve pain. Should be more cautious.

Researchers at Kaiser Moanalua Medical Center in Hawaii reviewed the health data of nearly 700 hip osteoarthritis patients and found that people who received steroid injections were 8.5 times more likely to develop rapid destructive hip disease (RDHD). This This disease can cause blood loss and death of hip bone tissue.

The incidence of RDHD is higher in patients who have received multiple and/or high-dose injections of the steroid triamcinolone acetonide. The risk of RDHD after a single low-dose injection is about 2%, but it rises to 5% after multiple low-dose injections or a single high-dose injection, and to 10% after multiple high-dose injections.

“Although the risk of RDHD after a single low-dose (40 mg or less) triamcinolone acetonide injection is low, the risk is higher after high-dose (80 mg or more) injections and multiple injections. These findings provide The information can be used to advise patients on the risks associated with this common procedure. In addition, caution should be exercised when using 80 mg of corticosteroids and multiple injections for intra-articular hip injections,” the lead author, MD, Hawaii Permanent Medical Group, Honolulu Kanu Okike wrote.

As they became more aware of the possible connection with RDHD, hospital plastic surgeons began to order fewer hip corticosteroid injections. In the following years, the number of RDHD cases decreased. The hospital also increased the discussion of post-injection RDHD in the patient’s informed consent procedure and stopped high-dose corticosteroid injections.

The research was recently published in this Journal of Bone and Joint Surgery, Is considered to be the largest post-injection RDHD patient so far.

Epidural injection

Two new studies also found that women who receive epidural injections to relieve pain during childbirth face a high risk of long-term headaches and chronic back pain if the needle accidentally pierces the endodural lining of the spinal cord. Dural puncture or “wet pumping” can cause leakage of spinal fluid, which can lead to serious neurological complications.

Pamela Flood, MD, professor of anesthesiology at Stanford University School of Medicine, said: “In my life, I may have had more than 10,000 epidural anesthesia, but I still get soaked from time to time. Faucet.” Anesthesiology News“But no matter how much we have seen, we still feel terrible about each one. We are working hard to alleviate people’s pain and give them a wonderful childbirth experience. The last thing we want to do is bring them complications.”

A study published in a journal anaesthetization It was found that more than half (58%) of women with accidental dural puncture still had headaches 18 months after epidural anesthesia, and nearly half (48%) had chronic low back pain.A recent study British Journal of Anesthesiology There are similar findings.

Dural puncture is relatively rare during epidural puncture. Women are usually warned of the risk of short-term headaches, but no long-term health problems.

“Although this information sneaked into our consciousness in the form of retrospective experiments, it was not confirmed through two large prospective trials until this year,” Vlad said. “Unfortunately, clinicians have been slow to hear this news, perhaps because we don’t want to admit that the short-term issues we have been discussing for years will have long-term effects on a large number of women.”

The two most common types of drugs used during epidural injections are anesthetics (lidocaine or bupivacaine) or corticosteroids (betamethasone, dexamethasone, hydrocortisone, methylprednisolone, Qu’anxilong).

In addition to treating childbirth pain, epidural steroid injections are also widely used to treat back pain. In the United States, approximately 9 million epidural steroid injections are performed every year, even if they are not approved by the FDA. The FDA warns that injecting steroids into the epidural space can cause rare but serious neurological problems, including vision loss, stroke, and paralysis. After receiving steroid injections for back pain, some patients also developed arachnoiditis, a chronic painful inflammation of the spinal cord.

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