Korean J Pain.  2015 Oct;28(4):280-283. 10.3344/kjp.2015.28.4.280.

Anaphylactic Shock Following Nonionic Contrast Medium during Caudal Epidural Injection

• Lee SH
• Park JW
• Hwang BM

• KMID: 2151671
• DOI: http://doi.org/10.3344/kjp.2015.28.4.280

Abstract

Caudal epidural injection is a common intervention in patients with low back pain and sciatica. Even though the complications of fluoroscopically directed epidural injections are less frequent than in blind epidural injections, complications due to contrast media can occur. We report a case of anaphylactic shock immediately after injection of an intravenous nonionic contrast medium (iohexol) during the caudal epidural injection for low back pain and sciatica in a patient without a previous allergic history to ionic contrast media (ioxitalamate). Five minutes after the dye was injected, the patient began to experience dizziness, and the systolic blood pressure dropped to 60 mmHg. Subsequently, the patient exhibited a mild drowsy mental state. About 30 minutes after the subcutaneous injection of 0.2 mg epinephrine, the systolic blood pressure increased to 90 mmHg. The patient recovered without any sequela. Life-threatening complications after injection of intravenous contrast medium require immediate treatment.

Keyword

Anaphylaxis; Caudal anesthesia; Contrast medium; Epidural analgesia; Hypotension; Intravascular; Sequelae; Shock

MeSH Terms

Analgesia, Epidural
Anaphylaxis*
Anesthesia, Caudal
Blood Pressure
Contrast Media
Dizziness
Epinephrine
Humans
Hypotension
Injections, Epidural*
Injections, Subcutaneous
Low Back Pain
Sciatica
Shock
Contrast Media
Epinephrine

Figure

• 

  Fig. 1 Fluoroscopic image showing intravascular injection of the nonionic contrast media (iohexol, Omnipaque®).

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