Flushing After Lumbar Epidural Steroid Injection with Dexamethasone

Area of Science:

• Pain Management
• Neurology
• Pharmacology

Background:

• Epidural steroid injections (ESIs) are common for low back pain.
• Flushing is a known side effect of ESIs, particularly with higher dexamethasone doses.
• Data on flushing with lower dexamethasone doses in ESIs is limited.

Purpose of the Study:

• To determine the incidence of flushing after lumbar ESIs using a low dose (4 mg) of dexamethasone.
• To investigate factors associated with flushing in this patient cohort.

Main Methods:

• Prospective cohort study of 80 participants undergoing lumbar ESIs.
• All participants received 4 mg of dexamethasone via fluoroscopically guided interlaminar or transforaminal injection.
• Flushing was assessed post-procedure and at 48 hours.

Main Results:

• A 5% incidence of flushing was observed (4 out of 80 participants).
• All flushing events occurred in female participants who received transforaminal injections.
• One immediate post-procedural flush and three within 48 hours were reported.

Conclusions:

• Low-dose (4 mg) dexamethasone in lumbar ESIs is associated with a low flushing rate (5%).
• Female sex and transforaminal injection technique may be associated with increased flushing risk.
• Further research can clarify risk factors and optimize ESI protocols.