From the Research
There is no established minimum ejection fraction (EF) requirement for epidural steroid injections (ESIs), and the decision to proceed should be based on individual patient assessment and clinical judgment. ESIs can generally be performed safely in patients with reduced cardiac function, including those with low ejection fractions. However, patients with severe heart failure (EF <30%) may be at higher risk for complications, and consultation with a cardiologist prior to the procedure may be prudent 1. The procedure itself places minimal cardiovascular stress on the patient compared to more invasive surgeries.
Key Considerations
- Clinical judgment should be exercised for patients with severe heart failure as they may be at higher risk for complications.
- The primary considerations for ESI safety relate to coagulation status, infection risk, and potential steroid-related side effects rather than ejection fraction.
- Patients with heart failure should be monitored more closely during and after the procedure, with attention to fluid status since steroids can cause fluid retention which may exacerbate heart failure symptoms.
- The benefits of pain relief and improved function from ESI should be weighed against any potential cardiovascular risks in patients with severely reduced cardiac function.
Recent Evidence
A recent study published in 2022 found that graded epidural anesthesia can be a safe alternative for patients with ischemic heart disease and low ejection fraction undergoing non-cardiac surgery 2. Another study from 2020 reported a case of selective spinal anesthesia in a patient with low ejection fraction who underwent emergent below-knee amputation without any apparent complications 1. These studies suggest that epidural procedures can be safely performed in patients with reduced cardiac function, but individual assessment and clinical judgment are crucial.
Clinical Implications
In clinical practice, the decision to proceed with ESI in patients with low ejection fraction should be based on a thorough evaluation of the patient's overall health status, including their cardiac function, coagulation status, and potential risks for complications. The benefits of ESI in improving pain and function should be carefully weighed against the potential risks, and patients with severe heart failure should be closely monitored during and after the procedure.