epidural abscess from lateral bb?

[100YardDash]

Ive heard of rare cases of facet joint injections causing epidural abscess and generalized infection from a septic joint. anyone ever heard of a case of epidural abscess following BBs?

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[Taus]

Havient heard of it, but also haven't heard of MBB or lbb q 3-4 months. What's rational for that?

 

[101N]

We performed sacral lateral branch blocks S1-3 (he gets these or MBBs every 3-4 months)

Why? Unnecessary procedures leading to a serious iatrogenic complication.

 

[lobelsteve]

Irrelevant. If he sues you get named. Can find somecjerk to review and blame this on the pain doc. And many of us would be happy to defend the pain doc. Because the error was injecting him with skin infection and already on prednisone while performing an experimental or investigational procedure. But lateral branches causing epidural absess in neck is makes no sense.

 

[pmrmd]

You guys are doing blocks with steroid, right? Probably coincidental, but offer the guy RF instead of recurrent [steroid?] injections

 

[100YardDash]

Im sorry guys. Please excuse my ignorance. This was my first month on a pain rotation. I believe he was getting seen every 6 months and had a sacral branch block 6 months prior..

 

[100YardDash]

Thanks Dr. Lobel. That answers my question

 

[Taus]

Ohhhh ok that makes much more sense. The only place where diagnostic blocks provide long term relief consistently is Paducah.

 

[willabeast]

i am guessing, but i suspect patient had unknown endocarditis before your injection. oral steroids were masking many of the symptoms. my reasoning is that it takes a lot longer than 5 days to get as infected as he got. do not feel bad, as ER also missed it first time. you might consider seeing if he had an elevated temperature when he came in.
best test to screen for endocarditis is an ESR but you have to think of it first.

 

[emd123]

Once you started with this, "65 yo M, PMH of chronic skin abscess/furunculosis w/ MSSA, DM (HA1c 6.4), eczema on prednisone 5mg daily" I'm not sticking a needles in that guy. Period.

That being said, blaming a cervical high thoracic epidural abscess on a non-epidural sacral procedure is a stretch. If you had said cervical ESI, that would be a different story. But sacral nerve blocks, is a stretch.

Chronic skin abscess, MRSA, diabetic with out of control A1c?

No. No. And no.