Ultrasound-guided caudal epidural steroid injection for successful treatment of radiculopathy during pregnancy

Musculoskeletal steroid injections in pregnancy: a review

Pregnant women experience a wide range of musculoskeletal pain disorders, which include general ailments occurring during pregnancy, exacerbation of pre-existing conditions, or pregnancy-specific pain/inflammatory conditions. There are significant concerns and knowledge gaps surrounding the safety, dosage, and potential long-term effects of several drugs used during pregnancy. Our article reviews the use of focal steroid injections during pregnancy. A mixture of case studies, meta-analyses, and randomised controlled trials have shown at least there is no adverse side effect to the mother or baby from maternal use of non-systemic injection during pregnancy and a significant improvement in symptoms of pain or paraesthesia can be achieved in patients that do not respond to more conservative measures. As with all patients, the use of steroid injection should be judged on a case-by-case basis to ensure that it is the most appropriate treatment choice. However, being pregnant should not be considered a contraindication to a single dose of non-systemic steroid administration, as these women can achieve significant symptomatic relief that reduces reliance on systemic medication and can significantly improve their quality of life.

Vasovagal Reactions during Interventional Pain Management Procedures—A Review of Pathophysiology, Incidence, Risk Factors, Prevention, and Management

Vasovagal reactions are a benign but common outcome of interventional pain management procedures that can negatively impact patient care, including aborted procedures and fear of future procedures that would otherwise help the patient. Research has been done on the incidence, risk factors, and management of vasovagal reactions resulting from such procedures, but less is known about how to prevent these reactions from occurring. In this paper, we present a literature review of the pathophysiology, incidence, risk factors, prevention, and management of vasovagal reactions during interventional pain management procedures, with an emphasis on the relative lack of research and conflicting advice on preventive measures. We found that moderate sedation and anxiolytics have been used prophylactically to prevent vasovagal reactions, but their side-effect profiles prevent them from being used commonly. Less studied is the prophylactic administration of antimuscarinics and IV fluids, despite the potential benefit of these measures and relatively low side-effect profile. We explore these topics here and offer advice for future research to fill the gaps in our knowledge.

Methods of Delivery in Pregnant Women with Lumbar Disc Herniation: A Narrative Review of General Management and Case Report

Low back pain is a common complaint during pregnancy, affecting approximately half of pregnant women. However, true disc herniation is extremely rare, and the majority of patients heal without surgery. The purpose of this study was to provide an overview of conservative management strategies and delivery modes for pregnant patients suffering from lumbar disc herniation without severe neurologic deficits that would require emergency surgery. We performed a narrative review of the literature using the PubMed database. Thirty-one articles were originally retrieved, out of which 7 met the inclusion criteria, compiling a total of 10 cases of parturient patients with lumbar disc hernia treated conservatively until childbirth. The preferred delivery mode was a Cesarean section, which was performed in 6 out of 10 cases. Two patients developed the cauda equina syndrome, one during a failed induction and the other patient 4 weeks after vacuum extraction. However, the second patient failed to improve after surgery. No patients developed cauda equina syndrome during or after the Cesarean section. Based on limited data, the Cesarean section seems to be preferred compared to vaginal delivery to avoid worsening symptoms and progression to the cauda equina syndrome.