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Related Concept Videos

Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

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...
Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

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...

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Related Experiment Video

Updated: Jun 5, 2026

Ultrasound-Guided Needle Release Combined with Corticosteroid Injection for the Treatment of Supinator Syndrome
05:18

Ultrasound-Guided Needle Release Combined with Corticosteroid Injection for the Treatment of Supinator Syndrome

Published on: May 26, 2023

ACR-ASNR-ASSR-SIR-SNIS Practice Parameter for the Performance of Image-Guided Epidural Steroid Injection.

Kristine A Blackham1, Timothy J Amrhein2, John D Barr3

  • 1From the University Hospital of Basel (K.A.B.), Dept of Radiology and Nuclear Medicine, Neuroradiology, Petersgraben 4, Basel 4056, Switzerland kristine.blackham@gmail.com.

AJNR. American Journal of Neuroradiology
|June 3, 2026
PubMed
Summary

Epidural steroid injections (ESI) offer significant pain relief and improved function for spinal conditions when performed correctly. Adhering to image guidance, proper technique, and physician training is crucial to maximize benefits and minimize rare neurologic risks.

Keywords:
Epidural steroid injectionImage-guided interventionInterventional pain managementRadiculopathySpine intervention

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Last Updated: Jun 5, 2026

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Area of Science:

  • Interventional Radiology
  • Pain Management
  • Spinal Procedures

Background:

  • Epidural steroid injections (ESI) are frequently utilized for managing spinal pain and radiculopathy unresponsive to conservative treatments.
  • A multidisciplinary approach is essential for optimizing patient outcomes.

Purpose of the Study:

  • To revise the practice parameter for epidural steroid injections (ESI).
  • To review evidence on the efficacy and safety of ESI.
  • To provide best practice recommendations for ESI procedures.

Main Methods:

  • Collaborative revision of the practice parameter by multiple professional societies including the American College of Radiology (ACR), American Brachytherapy Society (ABS), and others.
  • Adherence to the established ACR process for developing practice parameters and technical standards.

Main Results:

  • ESI can yield meaningful improvements in pain, mobility, function, and quality of life for selected patients, especially those with degenerative changes or radiculopathy.
  • Image guidance, meticulous technique, and thorough knowledge of spinal anatomy are advised due to potential neurologic risks.
  • The parameter outlines contraindications and emphasizes integrating ESI into multidisciplinary care pathways.

Conclusions:

  • This practice parameter offers guidance on indications, contraindications, patient selection, and technical execution for epidural steroid injections.
  • The recommendations aim to optimize therapeutic benefits while mitigating risks of serious neurologic and other complications.