JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (14) Citing Articles via Google Scholar Google Scholar Articles by Horlocker, T. T. Articles by Warfield, C. A. Search for Related Content PubMed PubMed Citation Articles by Horlocker, T. T. Articles by Warfield, C. A. Related Collections Regional Anesthesia Pain Pharmacology

---

PAIN MEDICINE

Risk Assessment of Hemorrhagic Complications Associated with Nonsteroidal Antiinflammatory Medications in Ambulatory Pain Clinic Patients Undergoing Epidural Steroid Injection

Terese T. Horlocker, MD^*, Zahid H. Bajwa, MD, Zubaira Ashraf, MD, Sajid Khan, MD, Jack L. Wilson, MD^*, Naveed Sami, MD, Christine Peeters-Asdourian, MD, Christopher A. Powers, MD^*, Darrell R. Schroeder, MS, Paul A. Decker, MS, and Carol A. Warfield, MD

Departments of *Anesthesiology and Health Sciences Research, Mayo Clinic, Rochester, Minnesota, and Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Address correspondence and reprint requests to Terese T. Horlocker, MD, Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905. Address e-mail to horlocker.terese{at}mayo.edu

We prospectively studied 1035 individuals undergoing 1214 epidural steroid injections to determine the risk of hemorrhagic complications. A history of bruising or bleeding was present in 176 (15%) patients. A platelet count was assessed in 77 patients before the epidural steroid injection; none was less than 100 x 10⁹/L. Nonsteroidal antiinflammatory drugs (NSAIDs) were reported by 383 (32%) patients, including 34 patients on multiple medications. Aspirin was the most common NSAID and was noted by 158 patients, including 104 patients on 325 mg or less per day. There were no spinal hematomas (major hemorrhagic complications). Blood was noted during needle or catheter placement in 63 (5.2%) patients (minor hemorrhagic complications). NSAIDs did not increase the frequency of minor hemorrhagic complications. However, increased age, needle gauge, needle approach, needle insertion at multiple interspaces, number of needle passes, volume of injectant, and accidental dural puncture were all significant risk factors for minor hemorrhagic complications. There were 42 patients with new neurologic symptoms or worsening of preexisting complaints that persisted more than 24 h after injection; median duration of the symptoms was 3 days (range, 1–20 days). Our results confirm those of previous studies performed in obstetric and surgical populations that document the safety of neuraxial techniques in patients receiving NSAIDs. We conclude that epidural steroid injection is safe in patients receiving aspirin-like antiplatelet medications. Minor worsening of neurologic function may occur after epidural steroid injection and must be differentiated from etiologies requiring intervention.

IMPLICATIONS: Previous studies performed in obstetric and surgical populations have demonstrated that antiplatelet therapy does not increase the risk of spinal hematoma associated with spinal or epidural anesthesia and analgesia. We confirm the safety of epidural steroid injection in patients receiving aspirin-like medications.

This article has been cited by other articles:

				I. A. Young, G. S. Hyman, L. N. Packia-Raj, and A. J. Cole The Use of Lumbar Epidural/Transforaminal Steroids for Managing Spinal Disease J. Am. Acad. Ortho. Surg., April 1, 2007; 15(4): 228 - 238. [Abstract] [Full Text] [PDF]

				C. Armon, C. E. Argoff, J. Samuels, and M.-M. Backonja Assessment: Use of epidural steroid injections to treat radicular lumbosacral pain: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology, March 6, 2007; 68(10): 723 - 729. [Abstract] [Full Text] [PDF]

				K. F. Layton, D. F. Kallmes, and T. T. Horlocker Recommendations for Anticoagulated Patients Undergoing Image-Guided Spinal Procedures AJNR Am. J. Neuroradiol., March 1, 2006; 27(3): 468 - 470. [Full Text] [PDF]

				G. Djaiani, L. Fedorko, and W. S. Beattie Regional Anesthesia in Cardiac Surgery: A Friend or A Foe? Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2005; 9(1): 87 - 104. [Abstract] [PDF]

				T. T. Horlocker Regional Anesthesia and Anticoagulation in Patients undergoing Cardiothoracic and Vascular Surgery Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2003; 7(4): 417 - 426. [Abstract] [PDF]

				P. J. S. Koo Acute Pain Management Journal of Pharmacy Practice, August 1, 2003; 16(4): 231 - 248. [Abstract] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999