Caudal Epidural Steroid Injection: Difference between revisions
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==Aftercare== | ==Aftercare== | ||
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. | 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:Spine]] | |||
[[Category:Procedures]] |
Revision as of 19:35, 17 June 2020
Equipment
Syringe | Needle | Dexamethasone | Further injectate | Total Volume |
20mL | 21G 40mm
25G 50mm |
15mg NB: Must be dexamethasone |
No lidocaine Add normal saline. |
L5: 10mL
L3: 15mL Upper lumbar: 20mL |
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.
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
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.