Epidural block procedure pitfalls

Objectives: To present a number of cases in which pitfalls may occur during the performance of epidural block, so that they may be prevented and corrected during the procedure. Materials and methods: A retrospective analysis was performed in 118 patients who suffered from lumbar pain, radicular pain or both and who underwent CT-guided minimally invasive anti-inflammatory analgesic treatment by selective injection of drugs in the epidural space, between January 2013 and April 2014. In all cases, a 21-G spinal needle was used to inject depot steroid (betamethasone 3 mg) and anesthetic (lidocaine 1 ml 2% + 0.5 ml bupivacaine 0.5%) or only steroidin those cases where perforation of the dura was suspected. The cases with pitfalls duringthe procedure were selected. Results: Five patients (4.23%) had technical complications during epidural block. Thecomplications were observed after an inadequate position of the needle tip (perforation ofthe dura and insufficient access to the epidural space), which were evidenced by direct aspirationof cerebrospinal fluid (CSF) or by air spread, which was used as a tracer prior to the druginjection. The errors were rapidly detected and corrected without any problems or need for further treatment. Conclusion: Epidural block is a practice that is frequently used in the management of chronic lumbarpain. Pitfalls and complications of the procedure are rare, but it is important that the physician should have the necessaryexperience and knowledge for their management and subsequent correction. © 2014 Sociedad Argentina de Radiología. Published by Elsevier Spain, S.L.U. Thisis an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).