Pain physician
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Observational Study
Volume of contrast and selectivity for lumbar transforaminal epidural steroid injection.
It has been shown that L4/L5 selective nerve root blocks become nonselective after injecting 1 mL and 0.5 mL of contrast. Volumes of less than 0.5 mL have not been used to determine a volume of definite specificity. ⋯ Diagnostic selective nerve root blocks limiting injectate to a single, ipsilateral segmental level cannot reliably be considered diagnostically selective with volumes as low as 0.2 mL. Also, spread of the contrast to the superior nerve root was more likely than spread to the inferior nerve root.
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There has been a recent surge in the literature highlighting the association of fentanyl as precipitating serotonin syndrome in patients on a serotonergic agent. ⋯ The incidence of serotonin syndrome in patients who receive both fentanyl and a serotonergic agent is low.