Horlocker Terese T, Bajwa Zahid H, Ashraf Zubaira, Khan Sajid, Wilson Jack L, Sami Naveed, Peeters-Asdourian Christine, Powers Christopher A, Schroeder Darrell R, Decker Paul A, Warfield Carol A
Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Anesth Analg. 2002 Dec;95(6):1691-7, table of contents. doi: 10.1097/00000539-200212000-00041.
We prospectively studied 1035 individuals undergoing 1214 epidural steroid injections to determine the risk of hemorrhagic complications. A history of bruising or bleeding was present in 176 (15%) patients. A platelet count was assessed in 77 patients before the epidural steroid injection; none was less than 100 x 10(9)/L. Nonsteroidal antiinflammatory drugs (NSAIDs) were reported by 383 (32%) patients, including 34 patients on multiple medications. Aspirin was the most common NSAID and was noted by 158 patients, including 104 patients on 325 mg or less per day. There were no spinal hematomas (major hemorrhagic complications). Blood was noted during needle or catheter placement in 63 (5.2%) patients (minor hemorrhagic complications). NSAIDs did not increase the frequency of minor hemorrhagic complications. However, increased age, needle gauge, needle approach, needle insertion at multiple interspaces, number of needle passes, volume of injectant, and accidental dural puncture were all significant risk factors for minor hemorrhagic complications. There were 42 patients with new neurologic symptoms or worsening of preexisting complaints that persisted more than 24 h after injection; median duration of the symptoms was 3 days (range, 1-20 days). Our results confirm those of previous studies performed in obstetric and surgical populations that document the safety of neuraxial techniques in patients receiving NSAIDs. We conclude that epidural steroid injection is safe in patients receiving aspirin-like antiplatelet medications. Minor worsening of neurologic function may occur after epidural steroid injection and must be differentiated from etiologies requiring intervention.
Previous studies performed in obstetric and surgical populations have demonstrated that antiplatelet therapy does not increase the risk of spinal hematoma associated with spinal or epidural anesthesia and analgesia. We confirm the safety of epidural steroid injection in patients receiving aspirin-like medications.
我们前瞻性地研究了1035例接受1214次硬膜外类固醇注射的患者，以确定出血并发症的风险。176例（15%）患者有瘀伤或出血史。77例患者在硬膜外类固醇注射前进行了血小板计数；均不低于100×10⁹/L。383例（32%）患者报告使用了非甾体抗炎药（NSAIDs），其中34例使用多种药物。阿司匹林是最常见的NSAIDs，158例患者使用，其中104例患者每日用量为325mg或更少。未发生脊髓血肿（主要出血并发症）。63例（5.2%）患者在置针或置管过程中出现血液（轻微出血并发症）。NSAIDs未增加轻微出血并发症的发生率。然而，年龄增加、针的规格、进针途径、在多个间隙进针、进针次数、注射剂体积和意外硬膜穿破均是轻微出血并发症的显著危险因素。42例患者在注射后出现持续超过24小时的新的神经症状或原有症状加重；症状的中位持续时间为3天（范围1 - 20天）。我们的结果证实了先前在产科和外科人群中进行的研究结果，这些研究证明了在接受NSAIDs的患者中神经轴技术的安全性。我们得出结论，在接受阿司匹林样抗血小板药物的患者中，硬膜外类固醇注射是安全的。硬膜外类固醇注射后可能会出现神经功能轻微恶化，必须与需要干预的病因相鉴别。
先前在产科和外科人群中进行的研究表明，抗血小板治疗不会增加与脊髓或硬膜外麻醉及镇痛相关的脊髓血肿风险。我们证实了在接受阿司匹林样药物的患者中硬膜外类固醇注射的安全性。
