A justified controversy about epidural particulate steroids

Authors

Keywords:

esteroides, corticoides, esteroides particulados, esteroides no particulados, epidural

Abstract

Introduction: Epidural administration of steroids is a cornerstone for the treatment of cervical and lumbosacral radicular pain.

Objective: To describe the physiological mechanisms and pharmacological characteristics of the corticosteroids used for pain treatment, as well as the complications derived from the epidural administration of particulate steroids.

Methods: A nonsystematic review of the literature was carried out, from July to September 2020, in scientific databases such as Cochrane Database of Systematic Reviews, Pubmed/Medline, EMBASE, Scopus, Web of Science, EBSCOhost, ScienceDirect, OVID and the academic search engine Google Scholar.

Development: The corticoids used in pain medicine are derived from prednisolone. These are classified into particulate (deposit, suspension) or non-particulate (dilution), depending on the presence or absence of a solid molecular component (ester-type molecules, insoluble in water). The most commonly used drugs are dexamethasone, betamethasone, triamcinolone, and methylprednisolone.

Conclusions: The epidural administration of particulate steroids is related to the incidence of serious, although infrequent, complications, such as paraplegia, tetraplegia, spinal cord infarction, hemorrhage and cerebral edema. Available evidence shows analgesic effectiveness similar to that of non-particulate compounds. Therefore, its routine usage is not recommended during the managment of the epidural space.

 

Keywords: steroids; corticoids; particulate steroids; non-particulate steroids; epidural.

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Author Biographies

Antonio Ismael Aparicio Morales, Complejo Científico Ortopédico Internacional Frank País

Especialista de Primer Grado en Anestesiología y Reanimación. Profesor Instructor

Alexis Ramón Pineda González, Hospital Pediátrico José Luis Miranda. Villa Clara

Especialista de Primer Grado en Anestesiología y Reanimación. Profesor Asistente

Yaima Rizo Fiallo, Complejo Científico Ortopédico Internacional Frank País

Especialista de Primer Grado en Ortopedia y Traumatología y Medicina General Integral

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Published

2022-01-05

How to Cite

1.
Aparicio Morales AI, Pineda González AR, Rizo Fiallo Y. A justified controversy about epidural particulate steroids. Rev Cub Anest Rean [Internet]. 2022 Jan. 5 [cited 2024 Dec. 22];20(3). Available from: https://revanestesia.sld.cu/index.php/anestRean/article/view/717

Issue

Vol. 20 No. 3 (2021): September - December (in progress)

Section

Review articles

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