While pain physicians debate technical issues of drug delivery, mechanisms of action and indications, our specialty needs to define the elements necessary to ensure patient safety. Epidural interventions can have profound physiologic effects, and prudent physicians will ensure that the full complement of drugs and equipment necessary for airway and circulatory resuscitation is readily available. The proximity to the spinal cord, exiting nerve roots and vascular structures requires practitioners to have skill and be vigilant. The potential for disaster is always present and is enhanced when variations in anatomy or selective techniques are contemplated. A more contentious issue is the necessity of fluoroscopy.
Fluoroscopic guidance is invaluable when using translaminar or transforaminal approaches.
Imaging equipment is essential when a procedure targets a specific localization or spread of medication. Many believe that fluoroscopy enhances the accuracy, safety and therapeutic benefit of epidural interventions. Fluoroscopy is invaluable to identify interspace location and helps confirm depth. Dye studies can precisely distinguish subcutaneous, intravascular or subarachnoid instillation. The rationale for having fluoroscopy available for CEIs and TEIs is sound and well founded.