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Revista Cubana de Anestesiología y Reanimación

2021, Number 3

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Revista Cubana de Anestesiología y Reanimación 2021; 20 (3)

A justified controversy about epidural particulate steroids

Aparicio MAI, Pineda GAR, Rizo FY

Language: Spanish
References: 59
Page: 1-16
PDF size: 422.98 Kb.


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.


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