1. 2004;7;427-429Flushing as a Side Effect Following Lumbar Transforaminal Epidural Steroid Injection
   A Prospective Evaluation
   Clifford R. Everett, MD, Michael N. Baskin, MD, David Speach, MD, Dmitry Novoseletsky, MD, and Rajeev Patel, MD.

Background:  Epidural steroid injections (ESI) are commonly used in managing radicular pain.  The risk of complications with epidural steroids is small, with the majority of complications being non-specific.  Flushing is a known side effect of corticosteroid administration.  The occurrence of flushing after epidural steroids has not been studied prospectively. 

 Objective:  To compare flushing as a side effect of Betamethasone acetate/Betamethasone sodium phosphate (Celestone®) vs. Methylprednisolone (DepoMedrol®) in fluoroscopically guided epidural steroid injections.

 Study Design:  Non-concurrent Prospective Database Study

 Methods:  Two-hundred forty patients, who underwent epidural steroid injections in the University of Rochester Spine Center in the year 2001 were included.
Eighty-one patients underwent epidural steroid injections with Celestone. One hundred fifty nine patients received treatment with Depo-Medrol.
Patients were contacted two days after the procedure by a staff member and specifically asked about the presence of flushing following steroid injection. The answers were recorded as “yes” or “no”.

Results:  Out of 81 patients who underwent ESI with Betamethasone acetate/Betamethasone sodium phosphate, 13 reported a flushing reaction (16%).  Out of 159 patients, who underwent ESI with Methylprednisolone, 14 reported a flushing reaction (9%).   This side effect difference was not statistically significant (p < 0.143 and odds ratio of 0.505).  The overall incidence of flushing was approximately 11%.

Conclusion:  Flushing reaction appears to be more widespread than previously assumed, with an overall incidence of 11%. There was no significant difference in self-reported flushing reactions following lumbar epidural steroid injections using either betamethasone or methylprednisolone. 

Keywords:  Epidural steroid injection, flushing, Celestone, betamethasone, Depo-Medrol, methylprednisolone, side effects