Caudal Epidural Steroid Injection: Difference between revisions
No edit summary |
No edit summary |
||
Line 40: | Line 40: | ||
Monitor for allergy. Advised to keep active within pain limits, and is reassessed about 10 days later. Steroid remains in situ for about 2 weeks. Up to 3-4 injections may be performed before declaring the therapy a failure. Max 0.6mg/kg or 40mg dexamethasone per year. | Monitor for allergy. Advised to keep active within pain limits, and is reassessed about 10 days later. Steroid remains in situ for about 2 weeks. Up to 3-4 injections may be performed before declaring the therapy a failure. Max 0.6mg/kg or 40mg dexamethasone per year. | ||
[[Category: | [[Category:Infoboxes]] | ||
[[Category:Partially complete articles]] | |||
[[Category:Spine Procedures]] | [[Category:Spine Procedures]] | ||
[[Category:Lumbar Spine Procedures]] |
Revision as of 18:50, 4 August 2020
Caudal Epidural Steroid Injection | |
---|---|
Indication | Radicular leg pain |
Syringe | 20mL |
Needle | 21G 40mm, or 25G 50mm |
Steroid | Must be dexamethasone, 15mg |
Local | No local, add normal saline |
Volume | L5: 10mL L3: 15mL Upper lumbar: 20mL |
Background
- Thecal sac ends at S2 (PSIS level)
Ultrasound Guided Technique
- Position: prone with heels rotated laterally, and a cushion pillow is used as an iliac wedge.
- Identify sacral cornua at base of imaginary triange with thumb (needle will go between cornua)
- Obtain a transverse image for the sacral hiatus and dorsal sacrococcygeal ligament between the bilateral sacral cornua,
- Obtain a longitudinal view and advance needle at a 45 degree angle.
- Terminate needle advancement right after piercing the sacrococcygeal ligament. This is to avoid injection into the venous plexus and intrathecal injection in those with unusually low terminating dural sacs.
- Aspirate to ensure needle not penetrated thecal sac or blood vessel. If aspirate CSF then abort procedure and retry in one week.
Non-Ultrasound Guided Technique
- Find and mark cornuae
- Infiltrate lidocaine to overlying soft tissue
- Enter at midline, feel it penetrate the membrane, aspirate, slow i.e. over 10 mins inject contents
- Assess post procedure for improvement in provocative manoeuvres such as SLR and pain
- Monitor (IV access?) Empty bladder
Indications
Good evidence for radicular leg pain due to lumbar disc herniation. 72.5% complete or partial pain relief at 12 weeks in those with symptom duration of 4-52 weeks. Fair evidence for axial pain and spinal stenosis and post surgery syndrome
Risks
Infection, subcutaneous injection, spinal cord infarction, Radiculopathy <1:2,000 paraplegia 1:50,000, allergic reaction, intravascular injection (minimal risks with dexamethasone due to small particulate size), dural puncture with headache, PE, ADR from steroids, increased back pain (3.1%)
Aftercare
Monitor for allergy. Advised to keep active within pain limits, and is reassessed about 10 days later. Steroid remains in situ for about 2 weeks. Up to 3-4 injections may be performed before declaring the therapy a failure. Max 0.6mg/kg or 40mg dexamethasone per year.