Flushing as a side effect following lumbar transforaminal epidural steroid injection

Abstract

Background: Epidural steroid injections (ESI) are commonly used in managing radicular pain. The risk of complications with epidural steroids is small, with the majority of complications being non-specific. Flushing is a known side effect of corticosteroid administration. The occurrence of flushing after epidural steroids has not been studied prospectively. Objective: To compare flushing as a side effect of Betamethasone acetate/Betamethasone sodium phosphate (Celestone®) vs. Methylprednisolone (DepoMedrol®) in fluoroscopically guided epidural steroid injections. Study Design: Non-concurrent Prospective Database Study Methods: Two-hundred forty patients, who underwent epidural steroid injections in the University of Rochester Spine Center in the year 2001 were included. Eighty-one patients underwent epidural steroid injections with Celestone. One hundred fifty nine patients received treatment with Depo-Medrol. Patients were contacted two days after the procedure by a staff member and specifically asked about the presence of flushing following steroid injection. The answers were recorded as "yes" or "no".. Results: Out of 81 patients who underwent ESI with Betamethasone acetate/Betamethasone sodium phosphate, 13 reported a flushing reaction (16%). Out of 159 patients, who underwent ESI with Methylprednisolone, 14 reported a flushing reaction (9%). This side effect difference was not statistically significant (p < 0.143 and odds ratio of 0.505). The overall incidence of flushing was approximately 11%. Conclusion: Flushing reaction appears to be more widespread than previously assumed, with an overall incidence of 11%. There was no significant difference in self-reported flushing reactions following lumbar epidural steroid injections using either beta-methasone or methylprednisolone.