Complications of Nausea, Vomiting, and Headache after Epidural Steroid Injection in Two Elderly Patients after Multilevel Lumbar Surgery: A Case Series
Abstract
Epidural steroid injection is an effective method for controlling spinal radicular pain. However, in elderly patients with a history of lumbar fusion surgery, anatomical changes can lead to complications such as headache, nausea, and vomiting after the injection. In this report, two patients, 70 and 75 years old, with a history of multilevel lumbar fusion surgery who developed these complications after epidural injection are presented. Conservative treatment, including furosemide and 3% hypertonic saline, was associated with complete improvement of symptoms.
[1] Lee MS, Moon HS. Safety of epidural steroids: a review. Anesth Pain Med (Seoul). 2021;16(1):16–27.
[2] Cohen SP, Greuber E, Vought K, Lissin D. Safety of Epidural Steroid Injections for Lumbosacral Radicular Pain: Unmet Medical Need. Clin J Pain. 2021 Sep 1;37(9):707-717.
[3] Proietti L, Scaramuzzo L, Schiro’ GR, Sessa S, Logroscino CA. Complications in lumbar spine surgery: A retrospective analysis. Indian J Orthop. 2013; 47(4):340–5.
[4] Carassiti M, Pascarella G, Strumia A, Russo F, Papalia GF, Cataldo R, Gargano F, Costa F, Pierri M, De Tommasi F, Massaroni C, Schena E, Agrò FE. Epidural steroid injections for low back pain: a narrative review. Int J Environ Res Public Health. 2022; 19(1):231.
[5] Benzon HT, Huntoon MA, Rathmell JP. Improving the safety of epidural steroid injections. JAMA. 2015;313(13):1313–4.
[6] Bosscher H. Pressure-volume relationships in the spinal canal and potential neurological complications after epidural fluid injections. Front Pain Res (Lausanne). 2022;3:878717.
[7] Manchikanti L, Falco FJ, Benyamin RM, Helm S 2nd, Singh V, Hirsch JA. Value-based interventional pain management: a review of Medicare national and local coverage determination policies. Pain Physician. 2013;16(3):E145–80.
[8] Hogan QH. Anatomy of the epidural space. Reg Anesth Pain Med. 1998;23(4):354–367.
[9] Reina MA, De Leon Casasola O, López A, De Andrés JA, Mora M, Fernández A. The origin of the spinal subdural space: ultrastructure findings. Anesth Analg. 2002 Apr;94(4):991-5
[10] Murakibhavi VG, Khemka AG. Caudal epidural steroid injection: a randomized controlled trial. Evid Based Spine Care J. 2011;2(4):19-26.
[11] Schwarz S, Georgiadis D, Aschoff A, Schwab S. Effects of hypertonic (10%) saline in patients with raised intracranial pressure after stroke. Stroke. 2002; 33(1):136–40.
[12] Shi J, Tan L, Ye J, Hu L. Hypertonic saline and mannitol in patients with traumatic brain injury: a systematic review and meta-analysis. Medicine (Baltimore). 2020;99(35):e21655.
[13] Wagner AL. CT fluoroscopy-guided epidural injections: technique and results. AJNR Am J Neuroradiol. 2004; 25(10):1821–3.
[14] Furman MB, Mehta AR, Kim RE, Simon JI, Patel R, Lee TS, Reeves RS. Injectate volumes needed to reach specific landmarks in lumbar transforaminal epidural injections. PM R. 2010; 2(7):625-35.
[2] Cohen SP, Greuber E, Vought K, Lissin D. Safety of Epidural Steroid Injections for Lumbosacral Radicular Pain: Unmet Medical Need. Clin J Pain. 2021 Sep 1;37(9):707-717.
[3] Proietti L, Scaramuzzo L, Schiro’ GR, Sessa S, Logroscino CA. Complications in lumbar spine surgery: A retrospective analysis. Indian J Orthop. 2013; 47(4):340–5.
[4] Carassiti M, Pascarella G, Strumia A, Russo F, Papalia GF, Cataldo R, Gargano F, Costa F, Pierri M, De Tommasi F, Massaroni C, Schena E, Agrò FE. Epidural steroid injections for low back pain: a narrative review. Int J Environ Res Public Health. 2022; 19(1):231.
[5] Benzon HT, Huntoon MA, Rathmell JP. Improving the safety of epidural steroid injections. JAMA. 2015;313(13):1313–4.
[6] Bosscher H. Pressure-volume relationships in the spinal canal and potential neurological complications after epidural fluid injections. Front Pain Res (Lausanne). 2022;3:878717.
[7] Manchikanti L, Falco FJ, Benyamin RM, Helm S 2nd, Singh V, Hirsch JA. Value-based interventional pain management: a review of Medicare national and local coverage determination policies. Pain Physician. 2013;16(3):E145–80.
[8] Hogan QH. Anatomy of the epidural space. Reg Anesth Pain Med. 1998;23(4):354–367.
[9] Reina MA, De Leon Casasola O, López A, De Andrés JA, Mora M, Fernández A. The origin of the spinal subdural space: ultrastructure findings. Anesth Analg. 2002 Apr;94(4):991-5
[10] Murakibhavi VG, Khemka AG. Caudal epidural steroid injection: a randomized controlled trial. Evid Based Spine Care J. 2011;2(4):19-26.
[11] Schwarz S, Georgiadis D, Aschoff A, Schwab S. Effects of hypertonic (10%) saline in patients with raised intracranial pressure after stroke. Stroke. 2002; 33(1):136–40.
[12] Shi J, Tan L, Ye J, Hu L. Hypertonic saline and mannitol in patients with traumatic brain injury: a systematic review and meta-analysis. Medicine (Baltimore). 2020;99(35):e21655.
[13] Wagner AL. CT fluoroscopy-guided epidural injections: technique and results. AJNR Am J Neuroradiol. 2004; 25(10):1821–3.
[14] Furman MB, Mehta AR, Kim RE, Simon JI, Patel R, Lee TS, Reeves RS. Injectate volumes needed to reach specific landmarks in lumbar transforaminal epidural injections. PM R. 2010; 2(7):625-35.
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| Section | Case Report(s) | |
| Keywords | ||
| Epidural injection steroid post-injection headache epidural complications furosemide hypertonic saline | ||
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How to Cite
1.
Asgari S, Hosseininasab SSM, Ahmadi H, Behnaz F. Complications of Nausea, Vomiting, and Headache after Epidural Steroid Injection in Two Elderly Patients after Multilevel Lumbar Surgery: A Case Series. Arch Anesth & Crit Care. 2026;.
