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LETTER TO THE EDITOR

Epidural Steroid Injections After Epidurography May Prevent Otherwise Devastating Complications

Department of Anesthesiology, SGPGIMS, Lucknow, India, mukesh_tripathi{at}yahoo.com

In Response:

We appreciate Dr. Narouze's interest in our case report (1) and we are grateful for his comments. We do not agree with his conclusion statement, "Tripathi et al. concluded that patient safety can be improved by excluding typical epidural doses of local anesthetic and/or opioids from epidural steroid injections" (2). We did not conclude this. Rather, we concluded with "we wish to remind pain practitioners of the possibility of this catastrophic event even in conscious patients and while using fluoroscopy as well." We again emphasize that even the conscious patient in pain might not react to an epidural needle piercing the dura or the cord, and thus patient response is not an adequate safeguard against this severe complication. We agree that the epidurography could have made a difference. However, we are unaware of any studies addressing whether the additional volume might dilute the drug or affect its distribution and, thus, cannot support adopting that for routine practice. We selected T11-12 because we wanted to inject the drug in close proximity with the roots involved (T12-L3).

References

1. Tripathi M, Nath SS, Gupta RK. Paraplegia after intracord injection during attempted epidural steroid injection in an awake-patient. Anesth Analg 2005;101:1209–11.[Abstract/Free Full Text]
2. Narouze S. Epidural steroid injections after epidurography may prevent otherwise devastating complications. Anesth Analg 2006;102:1585.[Free Full Text]

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