Purpose of Review
Systemic absorption of corticosteroids occurs following epidural administration. Central steroid response, including sleeplessness, flushing, and non-positional headache, insomnia, hiccups, flushing, and increased radicular pain, represents some of the most common immediate or delayed adverse event related to epidural steroid injections (ESI).
The systemic effects of corticosteroids themselves likely represent the most commonly encountered complications that result from ESI. These include hyperglycemia, hypothalamic-pituitary-adrenal axis suppression, decreased bone mineral density, and others.
This narrative review is an up-to-date summary of the literature related to adverse events following ESI which are attributable to the systemic effects of corticosteroids.
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•• El-Yahchouchi CA, Plastaras CT, Maus TP, Carr CM, McCormick ZL, Geske JR, et al. Adverse event rates associated with transforaminal and interlaminar epidural steroid injections: a multi-institutional study. Pain Med Malden Mass. 2016;17(2):239–49. https://doi.org/10.1111/pme.12896. This was a large, comprehensive recent review which noted central steroid response (sleeplessness, flushing, non-positional headache) was the most common adverse effect seen in 2.6% of 16,638 consecutive procedures (both TFESI and ILESI).
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Rosati, R., Schneider, B.J. Systemic Effects of Steroids Following Epidural Steroid Injections. Curr Phys Med Rehabil Rep 7, 397–403 (2019). https://doi.org/10.1007/s40141-019-00245-4
- Systemic effects
- HPA axis