Physicians Cautioned About Using Certain Radiocontrast Agents with Interventional Pain Medicine Procedures

Epidural steroid injections and epidural blood patches are procedures performed by pain medicine physicians to deliver medication into the spine to provide quick pain relief to patients. During these procedures, a small amount of dye is injected to identify the epidural space, a small space in the spine. This common practice guides the physician during the procedure to ensure the successful and safe delivery of the pain medication. 

Historically, the most used dye for these procedures has been iodine-based, as it is a safe option for most of the population. However, some patients can have allergic or other adverse reactions to iodine dye. As a result, physicians may opt to switch to something called gadolinium dye. However, gadolinium dye has been a focus of concern because it can unintentionally be injected deeper into the spinal tissue into what is known as the intrathecal space. When this happens, the results can be devastating.

A team of researchers at Mayo Clinic, led by Dr. Alejandro Hallo-Carrasco and Dr. Christine Hunt, reviewed three years of patients’ charts to identify adverse events in those who received gadolinium dye during epidural procedures. They identified adverse events in 2.73% of patients who received the gadolinium dye. The adverse events ranged from mild to life-threatening. For these reasons, Dr. Hallo-Carrasco reported that “It can be helpful to consult with allergy medicine specialists in some situations, and this should always be discussed with the doctor.” 

His team of researchers concluded that the risk of adverse events associated with gadolinium use in these procedures justifies a careful risk-benefit analysis to determine the safest way to proceed with epidural injections. 

The abstract The Hidden Risk of Gadolinium-Based Radiocontrast Agents During Interventional Pain Medicine Procedures was selected as of one of the 21st Annual Pain Medicine Meeting’s Resident/Fellow Travel Awards. Dr. Hallo-Carrasco will present the findings at a session on Friday, November 18, at 8 am, at the Hilton Bonnet Creek in Orlando, FL. Coauthors are Tesneem Abdel-Latif, BS, Johana Klasova, MD, Dan Yan, BSE, Jason S. Eldrige, MD, Alexei Gonzalez-Estrada, MD, and Christine Hunt, MD.

ASRA Pain Medicine is a membership society of more than 5,000 healthcare professionals devoted to advancing evidence-based practice of pain medicine across the pain continuum, from acute pain to chronic pain. Our mission is to advance the science and practice of regional anesthesia and pain medicine to improve patient outcomes through research, education, and advocacy. Our vision is to relieve the global burden of pain. We are committed to integrity, innovation, inclusiveness, service, compassion, and wellness. Learn more at