Generalized pruritus as an unusual side effect after epidural injection with dexamethasone.

A 51-year-old man with lumbar radiculopathy underwent a right L5 transforaminal epidural steroid injection with dexamethasone. One minute after the injection, the patient experienced severe pruritus and burning, which began in the groin and then spread throughout his body. The symptoms resolved completely after 1 minute, and the patient was discharged without any complications. Although there are a small number of publications reporting perineal pruritus after intravenous administration of dexamethasone, to our knowledge there is no report of a generalized reaction to an epidural dexamethasone injection such as the one described here.

Intravascular flow detection during transforaminal epidural injections: a prospective assessment.

BACKGROUND: Transforaminal epidural steroid injections (TFESI) are a mainstay in the treatment of spine pain. Though this commonly performed procedure is generally felt to be safe, devastating complications following inadvertent intra-arterial injections of particulate steroid have been reported. The use of digital subtraction angiography (DSA) has been suggested as a means of detecting intra-arterial needle placements prior to medication injection. OBJECTIVE: To examine the efficacy of DSA in detecting intra-arterial needle placements during TFESI. STUDY DESIGN: Prospective cohort study evaluating the impact of DSA on detecting intra-arterial needle placements during TFESI. METHODS: We enrolled 150 consecutive patients presenting to a university-affiliated spine center with discogenic and/or radicular symptoms affecting the cervical, lumbar, and sacral regions. For each injection, prior to imaging with DSA, traditional methods for vascular penetration detection were employed, including the identification of blood in the needle hub (flash), negative aspiration of blood prior to injection, and live fluoroscopic injection of contrast. Once these tests were performed and negative for signs of intra-arterial needle placement, DSA imaging was utilized prior to medication administration for identification of vascular flow. RESULTS: A total number of 222 TFESI were performed, 41 injections at the cervical levels (18.47%), 113 at the lumbar levels (50.9%), and 68 at the sacral levels (30.36%). Flash was observed in 13 injections performed (5.85% of the total number of injections): one (0.45%) in the cervical, 2 (0.9%) in the lumbar, and 10 (4.5%) in the sacral levels. In 11 TFESI blood aspiration was obtained (4.95% of all injections): 3 (1.3%) in cervical, 4 (1.8%) in lumbar, and 4 (1.8%) in sacral injections. Live fluoroscopy during contrast injection detected 46 (20.72%) intravascular flow patterns: 7 (3.1%) cervical, 17 (7.6%) lumbar, and 22 (9.9%) sacral. DSA identified an additional 5 intravascular injections after all previous steps had resulted in negative vascular penetration signs, which accounted for 2.25% of all injections. LIMITATIONS: This is a prospective, single-center study with a relatively small number of patients and no control group. CONCLUSION: DSA detected additional 5.26% intravascular needle placements following traditional methods. Our findings also support other studies that conclude TFESI are generally a safe procedure. We recommend that special attention should be paid to the sacral injections as vascular penetration was statistically higher than at other levels.

The teaching of acupuncture in the University of São Paulo School of Medicine, Brazil.

OBJECTIVE: Since being introduced as an elective discipline (non-obligatory) in the second semester of 2002, acupuncture has been taught in the University of São Paulo School of Medicine. We conducted this study to verify interest and acceptance among under graduate medical students and to discern a positive influence contributing to improving their skills. METHODS: The study was conducted from 2002 to 2007 using descriptive statistical methods. RESULTS: The average number of students who concluded the discipline is 24.9 students per semester with an average number of medical students per semester of 87.5 (28% of all medical students in the 7th and 8th semesters). After a semester of basic training in acupuncture, only eight students per group are promoted (after selection) to the Medical Academic League of Acupuncture which lasts for two years. Every semester, all eight vacancies are filled. Among the students who concluded the course, 98% described course quality as good or very good, 85% considered themselves at least partially able to use acupuncture and 79% stated that the course influenced them in their medical education. CONCLUSION: There is a genuine interest to learn acupuncture, almost 30% of all students volunteer for a brief training in acupuncture while some of them choose additional training of two years due to the importance of acupuncture as part of professional skills. Results indicate that acupuncture should be included as an elective discipline for medical students.

The teaching of acupuncture in the University of São Paulo School of Medicine, Brazil / O ensino da acupuntura na Faculdade de Medicina da Universidade de São Paulo, Brasil

OBJECTIVE: Since being introduced as an elective discipline (non-obligatory) in the second semester of 2002, acupuncture has been taught in the University of São Paulo School of Medicine. We conducted this study to verify interest and acceptance among under graduate medical students and to discern a positive influence contributing to improveing their skills. METHODS: The study was conducted from 2002 to 2007 using descriptive statistical methods. RESULTS: The average number of students who concluded the discipline is 24.9 students per semester with an average number of medical students per semester of 87.5 (28 percent of all medical students in the 7th and 8th semesters). After a semester of basic training in acupuncture, only eight students per group are promoted (after selection) to the Medical Academic League of Acupuncture which lasts for two years. Every semester, all eight vacancies are filled. Among the students who concluded the course, 98 percent described course quality as good or very good, 85 percent considered themselves at least partially able to use acupuncture and 79 percent stated that the course influenced them in their medical education. CONCLUSION: There is a genuine interest to learn acupuncture, almost 30 percent of all students volunteer for a brief training in acupuncture while some of them choose additional training of two years indue to the importance of acupuncture as part of professional skills. Results indicate that acupuncture should be included as an elective discipline for medical students.

OBJETIVO: Após ter sido introduzida como disciplina eletiva (não obrigatória) no segundo semestre de 2002, a acupuntura tem sido ensinada na Faculdade de Medicina da Universidade de São Paulo (FMUSP) desde então. Esse estudo foi realizado com o intuito de verificar o interesse e a aceitação da acupuntura entre os estudantes de medicina da FMUSP e se, de alguma forma, ela poderia influenciá-los positivamente, contribuindo para melhorar as suas competências. MÉTODOS: O estudo foi conduzido durante o período de 2002 a 2007, utilizando-se métodos de estatística descritiva. RESULTADOS: A média de todos os estudantes que concluíram a disciplina foi de 24,9 alunos por semestre, sendo que a média de estudantes de medicina por semestre é de 87,5 (28 por cento de todos os estudantes de medicina nos 7º e 8º semestres). Após o primeiro semestre de formação básica em acupuntura, apenas oito alunos por grupo são promovidos (após seleção) para a Liga Médica Acadêmica de Acupuntura, que tem a duração de dois anos. Em todos os semestres, as oito vagas são preenchidas. Entre os estudantes que concluíram o curso, 98 por cento consideraram-no de boa ou muito boa qualidade, 85 por cento consideravam-se parcialmente capazes para empregar a acupuntura e 79 por cento consideraram que o curso contribuiu para a sua educação médica. CONCLUSÃO: Existe um real interesse para a aprendizagem da acupuntura, pois em torno de 30 por cento de todos os alunos quiseram passar por um breve treinamento em acupuntura, alguns deles optando por uma formação de dois anos em reconhecimento à importância da acupuntura como parte da capacitação profissional. Os resultados sugerem que a acupuntura deve ser incluída como uma disciplina eletiva para alunos de medicina.