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Related Concept Videos

Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

421
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
421
Local Anesthetics: Adverse Effects01:12

Local Anesthetics: Adverse Effects

399
While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
399
Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

107
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
107
Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

591
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
591
Skeletal Muscle Relaxants: Adverse Effects01:21

Skeletal Muscle Relaxants: Adverse Effects

345
Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
Unlike...
345
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

376
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
376

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Perspective/short review: Diagnosis and surgery for mostly dorsal thoracic spinal arachnoid webs with/ without Syrinxes and/or Spinal Arachnoid Cysts.

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Retained foreign bodies in spine surgery: Never events, near never events, but not just adverse events.

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Perspective/short review: Mandatory intraoperative neurological monitoring (IONM) for thoracic ossification of the posterior longitudinal ligament (OPLL).

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Review/Short Perspective: "Never Events" likely never occur without a breach in the standard of care (SOC) while "Near Never Events" are typically not far behind.

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Related Experiment Video

Updated: Jun 11, 2025

Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
03:14

Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy

Published on: January 31, 2025

295

Perspective: Risks/adverse events for epidural spinal injections.

Nancy E Epstein1, Marc A Agulnick2

  • 1Professor of Clinical Neurosurgery, School of Medicine, State University of NY at Stony Brook and Editor-in-Chief Surgical Neurology International NY, USA, and c/o Dr. Marc Agulnick, 1122 Franklin Avenue Suite 106, Garden City, NY, USA.

Surgical Neurology International
|October 7, 2024
PubMed
Summary
This summary is machine-generated.

Cervical and lumbar epidural spinal injections offer little short-term or long-term benefit for back pain and radiculopathy. These procedures, including interlaminar (ESI) and transforaminal (TFESI) injections, also carry risks of adverse events, particularly with cervical treatments.

Keywords:
Adverse EventsCaudal: CervicalCerebrospinal Fluid (CSF) LeaksCord InjectionsLumbarNeurological DeficitsParalysisSpinal Epidural Injections: InterlaminarTransforaminal (TFESI)Translaminar (ESI)Vascular Injections

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Area of Science:

  • Pain Management
  • Neurosurgery
  • Interventional Radiology

Background:

  • Cervical and lumbar epidural spinal injections are common US procedures for pain and radiculopathy, despite lacking FDA approval.
  • Key types include interlaminar (ESI), transforaminal (TFESI), and caudal injections.
  • Most studies show minimal short-term and no long-term efficacy compared to placebos.

Purpose of the Study:

  • To evaluate the efficacy and safety of cervical and lumbar epidural spinal injections.
  • To compare adverse events between different injection types and locations.

Main Methods:

  • Systematic review of studies comparing epidural spinal injections (ESI, TFESI) with placebos.
  • Analysis of reported adverse events (AE) associated with cervical and lumbar injections.

Main Results:

  • Cervical injections showed more adverse events than lumbar injections.
  • Transforaminal injections (TFESI) had more severe adverse events than interlaminar injections (ESI), especially in the cervical spine.
  • Adverse events included neurological deficits, strokes, infections, hematomas, and CSF leaks.

Conclusions:

  • Epidural spinal injections provide minimal to no short-term or long-term benefits for cervical and lumbar pain/radiculopathy.
  • Cervical injections carry a higher risk of adverse events than lumbar injections.
  • Transforaminal epidural spinal injections are associated with more adverse events than interlaminar injections.