Complications of Interventional Pain Management Techniques
Several textbooks cover the techniques, indications, contraindications, and the mechanism of action of the interventional pain management techniques, but only few textbooks have focused on the complications and on their consequences. Interventional pain m
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Marco Araujo and Dermot More O’Ferrall
Key Points
• The most common reported complications are medication-related misuse, pneumothorax, spinal cord injury, and nerve damage. • Intrathecal injection of 10 ml of preservative-free normal saline can reduce the potential for postdural-puncture headache after a dural puncture. • Other causes of headache following epidural steroid injection include intracranial or subdural hematoma, epidural abscess, meningitis, and pneumocephalus. • Frequently, the ligamentum flavum is adherent to the dura above C5 spinal level. • Injection of particulate steroids can lead to anterior spinal cord syndrome. Use of nonparticulate steroids and inferoposterior foraminal needle placement reduces the risk of paraplegia after transforaminal epidurals. • The use of lateral fluoroscopic guidance for trigger point injections of the thoracic wall musculature reduces the risk of pneumothorax. • Radiofrequency needle placement close to the nerve root can cause severe postoperative dysesthesia and nerve root and spinal cord injury. • Right-sided SGB may cause sinus arrhythmias, while left-sided SGB can cause left ventricular dysfunction in patients with preexisting left ventricular disease.
M. Araujo, M.D., FACIP (*) Pain Clinic Advanced Pain Management, 4131 W. Loomis Rd Ste 300, Greenfield, WI 54301, USA e-mail: [email protected] D.M. O’Ferrall, M.D. Pain Clinic Advanced Pain Management, 4131 W. Loomis Rd Ste 300, Greenfield, WI 53221, USA e-mail: [email protected]
• Contrast volume should be maximum of half (0.5) ml/disc in cervical discography. • Warfarin should be stopped five (5) days prior to neuraxial procedure, and the INR should be less than 1.4 before proceeding.
Introduction Several textbooks cover the techniques, indications, contraindications, and the mechanism of action of the interventional pain management techniques, but only few textbooks have focused on the complications and on their consequences. Interventional pain management has evolved tremendously since the first described therapeutic nerve block, performed by Tuffer in 1899 [1, 2]. The combination of Interventional Pain Physicians with small amount of experience in the field and the recent significant increase in the utilization of interventional diagnostic and therapeutic techniques raises the potential for increased complications. Unfortunately, there are major limitations in the analysis of complications. Historically, physicians have a tendency to report no poor outcomes; therefore, only few complications are reported. Health privacy issues and fear of litigation prevent several physicians from reporting the complications of interventional techniques. Furthermore, the complications may be reported to different databases, making the analysis even more difficult. The American Society of Anesthesiologists (ASA) Closed Claims Project Database can provide valuable information on the adverse outcomes in chronic pain management from 1970 through December 2000 [3]. During this time period, 284 chronic pain mana
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