FDA reviewed a sampling of cases from the FDA Adverse Event Reporting System (FAERS) database, as well as cases in the medical literature of serious neurologic adverse events associated with epidural corticosteroid injections. 2-16 Serious adverse events included death, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, stroke, seizures, nerve injury, and brain edema. Many cases were temporally associated with the corticosteroid injections, with adverse events occurring within minutes to 48 hours after the corticosteroid injections. In some cases, diagnoses of neurologic adverse events were confirmed through magnetic resonance imaging or computed tomography scan. Many patients did not recover from these reported adverse events.
Epidural steroid injections are most commonly used in situations of radicular pain, which is a radiating pain that is transmitted away from the spine by an irritated spinal nerve. Irritation of a spinal nerve in the low back ( lumbar radiculopathy ), such as from lumbar spinal stenosis , cervical spinal stenosis, herniated disc , and foraminal encroachment, causes back pain that goes down the leg. Epidural injection is also used as a minimally invasive procedure to treat nerve compression in the neck (cervical spine), referred to as cervical radiculopathy , which causes pain.
As already mentioned, neuraxial morphine is generally not used in for labor analgesia. In some situations however the use of intrathecal morphine may be beneficial. The analgesic effect of small amount of spinal morphine in combination with very small dose of local anesthetic may last several hours, though both the duration and the degree of pain relief are variable. For patients who are well progressed in labor the effect may last long enough to provide pain relief until the baby is born. Recent study indicates that about sixty percent of women in labor who receive spinal block in this fashion get satisfactory pain relief for their childbirth. Single shot spinal does not require close monitoring of the patients, and this method – though not optimal – may be suitable for places with limited healthcare resources.