Benzon Honorio T, Elmofty Dalia, Shankar Hariharan, Rana Maunak, Chadwick Andrea L, Shah Shalini, Souza Dmitri, Nagpal Ameet S, Abdi Salahadin, Rafla Christian, Abd-Elsayed Alaa, Doshi Tina L, Eckmann Maxim S, Hoang Thanh D, Hunt Christine, Pino Carlos A, Rivera Jessica, Schneider Byron J, Stout Alison, Stengel Angela, Mina Maged, FitzGerald John D, Hirsch Joshua A, Wasan Ajay D, Manchikanti Laxmaiah, Provenzano David Anthony, Narouze Samer, Cohen Steven P, Maus Timothy P, Nelson Ariana M, Shanthanna Harsha
Anesthesiology, Feinberg School of Medicine, Chicago, Illinois, USA
Department of Anesthesia, University of Chicago Medical Center, Chicago, Illinois, USA.
Reg Anesth Pain Med. 2025 Mar 12. doi: 10.1136/rapm-2024-105593.
There is potential for adverse events from corticosteroid injections, including increase in blood glucose, decrease in bone mineral density and suppression of the hypothalamic-pituitary axis. Published studies note that doses lower than those commonly injected provide similar benefit.
Development of the practice guideline was approved by the Board of Directors of American Society of Regional Anesthesia and Pain Medicine with several other societies agreeing to participate. The scope of guidelines was agreed on to include safety of the injection technique (landmark-guided, ultrasound or radiology-aided injections); effect of the addition of the corticosteroid on the efficacy of the injectate (local anesthetic or saline); and adverse events related to the injection. Based on preliminary discussions, it was decided to structure the topics into three separate guidelines as follows: (1) sympathetic, peripheral nerve blocks and trigger point injections; (2) joints; and (3) neuraxial, facet, sacroiliac joints and related topics (vaccine and anticoagulants). Experts were assigned topics to perform a comprehensive review of the literature and to draft statements and recommendations, which were refined and voted for consensus (≥75% agreement) using a modified Delphi process. The United States Preventive Services Task Force grading of evidence and strength of recommendation was followed.
This guideline deals with the use and safety of corticosteroid injections for sympathetic, peripheral nerve blocks and trigger point injections for adult chronic pain conditions. All the statements and recommendations were approved by all participants after four rounds of discussion. The Practice Guidelines Committees and Board of Directors of the participating societies also approved all the statements and recommendations. The safety of some procedures, including stellate blocks, lower extremity peripheral nerve blocks and some sites of trigger point injections, is improved by imaging guidance. The addition of non-particulate corticosteroid to the local anesthetic is beneficial in cluster headaches but not in other types of headaches. Corticosteroid may provide additional benefit in transverse abdominal plane blocks and ilioinguinal/iliohypogastric nerve blocks in postherniorrhaphy pain but there is no evidence for pudendal nerve blocks. There is minimal benefit for the use of corticosteroids in trigger point injections.
In this practice guideline, we provided recommendations on the use of corticosteroids in sympathetic blocks, peripheral nerve blocks, and trigger point injections to assist clinicians in making informed decisions.
皮质类固醇注射存在不良事件的风险，包括血糖升高、骨密度降低以及下丘脑 - 垂体轴抑制。已发表的研究表明，低于常用注射剂量也能提供类似的益处。
该实践指南的制定获得了美国区域麻醉与疼痛医学学会董事会的批准，其他几个学会也同意参与。指南的范围确定为包括注射技术的安全性（体表标志引导、超声或放射学辅助注射）；皮质类固醇的添加对注射剂（局部麻醉剂或生理盐水）疗效的影响；以及与注射相关的不良事件。基于初步讨论，决定将主题分为三个单独的指南，如下：（1）交感神经、周围神经阻滞和触发点注射；（2）关节；（3）神经轴、小关节、骶髂关节及相关主题（疫苗和抗凝剂）。专家被分配主题以对文献进行全面综述，并起草声明和建议，通过改良的德尔菲法对其进行完善并投票达成共识（≥75% 同意）。遵循美国预防服务工作组的证据分级和推荐强度。
本指南涉及皮质类固醇注射在成人慢性疼痛病症的交感神经、周围神经阻滞和触发点注射中的使用及安全性。经过四轮讨论，所有参与者均批准了所有声明和建议。参与学会的实践指南委员会和董事会也批准了所有声明和建议。包括星状神经节阻滞、下肢周围神经阻滞和一些触发点注射部位在内的一些操作，通过影像引导可提高安全性。在局部麻醉剂中添加非颗粒状皮质类固醇对丛集性头痛有益，但对其他类型的头痛无益。皮质类固醇在疝修补术后疼痛的腹横肌平面阻滞和髂腹股沟/髂腹下神经阻滞中可能提供额外益处，但在阴部神经阻滞中尚无证据支持。在触发点注射中使用皮质类固醇益处极小。
在本实践指南中，我们提供了关于皮质类固醇在交感神经阻滞、周围神经阻滞和触发点注射中的使用建议，以帮助临床医生做出明智的决策。
