Epidurals during Infection

[painfre]

Is an ongoing strepthroat or UTI on antibiotics contraindiaction for Epidurals or peripheral nerve blocks ? joint injections

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[knoxdoc]

No. As long as the infection is not in immediate proximity to my needle (i.e. no cellulitis or soft tissue infection) I will do the procedure if they have had antibiotics on board for at least 48 hours and are improving clinically. Obviously must be afebrile, no chills, etc.

My staff can sniff out mild infections from a mile away because they look for any excuse to not do a procedure. "He sneezed one time about three days ago, do you still want to do the SI injection doctor?"

 

[clubdeac]

I remember Slipman saying at ISIS two years ago that he waits 2 weeks to do ESIs on patients who have had dental work, colonoscopy, etc due to transient bacteremia and the possibility of tracking it into the epidural space. If that's the case then surely he wouldn't recommend an ESI until complete resolution of infx and completion of antibx. Right? Hmmmm, would be interested in others input.

 

[Aether2000]

The epidural space is quite resistant to infection. The number of epidural abscesses is exceedingly low, even in labor patients coated in sweat, amniotic fluid, and feces. There would be no data available to support holding on epidural injections after colonoscopy or other minimally invasive procedures, and I would surmise this position is based on personal preference rather than on any science. But if there is lit out there, bring it on. The real issue is not epidural infection, but penetration of the dura accidentally and causing meningitis, which is much easier to do. Fortunately, pain medicine physicians performing epidural injections are not as cavalier as anesthesiologists doing the same since we use fluoroscopy for needle advancement. The safe view on fluoro will always beat a blind epidural.

 

[lobelsteve]

I'll cancel if not on ABX x24 hrs or if with temp > 101

 

[SSdoc33]

if a patient has had a tooth abscess or root canal, i am very wary. otherwise, the risk is very minimal.

 

[Tenesma]

i do not perform ESIs if they had a recent flu shot.... i just got tired of all the phone calls about constitutional complaints attributed to the ESI when in fact it was the flu shot....

 

[PMR 4 MSK]

48 hours of antibiotics and no fevers.

 

[mid|ine]

I am overly conservative, but if they are on ABx for infection I won't do a procedure. If temp is >100 F I won't inject. I am busy enough and make plenty of money, no reason to risk it, IMHO.

 

[Aether2000]

Same...101 cutoff. I have too many patients who tell me they are running a fever of 98 and need to cancel...

 

[Tenesma]

anybody with an infection needs to be OFF antibiotics for 14 days...

completely arbitrary... but i have had a few patients who had injections with return of the infection 1-2 days later, only to be yelled at by ID/ortho/PCP that the steroid injection depressed their immune system allowing the resurgence of the infection...

most patients haven't complained about that policy

 

[kdlymes]

i do not perform ESIs if they had a recent flu shot.... i just got tired of all the phone calls about constitutional complaints attributed to the ESI when in fact it was the flu shot....

You too.

 

[Mister Mxyzptlk]

My nurse gave me a flu shot last week. I waited 30 minutes and then called the main number complaining that I had just received a shot and that the area was painful and tender and I wanted to speak with the doctor.

 

[pjuer]

My nurse gave me a flu shot last week. I waited 30 minutes and then called the main number complaining that I had just received a shot and that the area was painful and tender and I wanted to speak with the doctor.

Were you able to speak with him? 😀

 

[kdlymes]

Same...101 cutoff. I have too many patients who tell me they are running a fever of 98 and need to cancel...

Me too and pretty standard.