LESI LESI Complications and Risks 2 — Questions and Answers
Question 1: An epidural hematoma after LESI is most likely to occur in patients who:
- Are older than 65 years
- Are taking anticoagulant or antiplatelet medications (Correct answer)
- Have a history of diabetes
- Are receiving physical therapy concurrently
Correct answer: Are taking anticoagulant or antiplatelet medications
Patients on anticoagulant or antiplatelet therapy have impaired hemostasis and are at significantly increased risk of epidural hematoma formation following ESI.
Question 2: Steroid flare after ESI is characterized by:
- Severe infection requiring antibiotics
- Temporary increase in pain 24-48 hours after injection (Correct answer)
- Anaphylaxis requiring epinephrine
- Permanent neurological deficit
Correct answer: Temporary increase in pain 24-48 hours after injection
Steroid flare is a transient worsening of pain occurring 24-48 hours post-injection, likely due to a local inflammatory reaction to the crystalline steroid particles, and resolves spontaneously.
Question 3: Which symptom after LESI should prompt immediate emergency evaluation for cauda equina syndrome?
- Mild soreness at the injection site
- Transient leg weakness for 2 hours
- Bilateral leg weakness, saddle anesthesia, and bowel/bladder dysfunction (Correct answer)
- Mild headache when standing
Correct answer: Bilateral leg weakness, saddle anesthesia, and bowel/bladder dysfunction
Bilateral leg weakness, saddle anesthesia, and bowel or bladder dysfunction suggest cauda equina syndrome, a neurological emergency requiring urgent imaging and possible surgical decompression.
Question 4: Facial flushing and increased energy occurring 1-2 days after an ESI are most likely caused by:
- Allergic reaction to contrast dye
- Systemic corticosteroid effects (steroid flush) (Correct answer)
- Intravascular local anesthetic injection
- Infection with bacteremia
Correct answer: Systemic corticosteroid effects (steroid flush)
Facial flushing, increased energy, insomnia, and mood changes in the 1-2 days following ESI are common systemic effects of absorbed corticosteroid and are generally benign.
Question 5: Which of the following best describes the risk of infection (epidural abscess) following a single ESI?
- Very common, occurring in 1 in 10 injections
- Rare, estimated at approximately 1 in 1,000 to 1 in 100,000 (Correct answer)
- Never reported in the literature
- Common only with corticosteroid use
Correct answer: Rare, estimated at approximately 1 in 1,000 to 1 in 100,000
Epidural abscess after ESI is rare, with estimates ranging from approximately 1 in 1,000 to 1 in 100,000 injections, but can be devastating if not recognized early.
Question 6: In the event of a vasovagal reaction during LESI, the first-line treatment is:
- Intravenous epinephrine 0.3 mg
- Place patient supine, elevate legs, and administer IV fluids and atropine if bradycardic (Correct answer)
- Administer oral antihistamines
- Terminate the procedure and discharge immediately
Correct answer: Place patient supine, elevate legs, and administer IV fluids and atropine if bradycardic
Vasovagal reactions are managed by placing the patient supine with legs elevated to restore venous return, and IV atropine is given for symptomatic bradycardia.
LESI LESI Complications and Risks 2
An epidural hematoma after LESI is most likely to occur in patients who: