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International Pain and Spine Intervention Society Emergency Protocols: Intradural or Intrathecal Local Anesthetic
Ameet S Nagpal1, Stephan Klessinger2, Patrick H Waring3
1Medical University of South Carolina College of Medicine, Charleston, SC, USA.
Interventional Pain Medicine
|June 15, 2026
Summary
Unintentional intrathecal injection during epidural procedures can cause serious neurologic and cardiopulmonary issues. Recognizing abnormal contrast flow and using fluoroscopic imaging are key to prevention and proper emergency management.
Area of Science:
- Anesthesiology
- Neurosurgery
- Emergency Medicine
Background:
- Epidural procedures carry a risk of inadvertent intradural or intrathecal injection.
- Such injections can lead to severe neurologic and cardiopulmonary complications.
Purpose of the Study:
- To review the risks and consequences of unintentional intrathecal injection during epidural procedures.
- To highlight methods for preventing and managing this complication.
Main Methods:
- Review of protocols and clinical guidelines for epidural procedures.
- Emphasis on recognizing abnormal contrast flow patterns on imaging.
- Utilization of multiplanar fluoroscopic imaging for needle placement verification.
Main Results:
- Failure to recognize abnormal contrast flow increases risk of intrathecal injection.
- Multiplanar fluoroscopic imaging aids in preventing inadvertent needle placement.
- Prompt recognition and management are crucial for patient outcomes.
Conclusions:
- Preventing unintentional intrathecal injection requires vigilance and appropriate imaging techniques.
- Early detection of abnormal contrast flow is critical.
- Effective emergency management protocols are essential to mitigate severe consequences.
Keywords:
EmergenciesEmergency protocolInterventional pain proceduresIntradural injectionIntrathecal injectionRisk mitigationMore Related Videos
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