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Analysis of judicial precedent cases regarding epidural injection in chronic pain management in Republic of Korea
  1. Soo Ick Cho1,
  2. SuHwan Shin2,3,
  3. Haesun Jung4,
  4. Jee Youn Moon4,5 and
  5. Ho-Jin Lee4,5
  1. 1Department of Dermatology, Seoul National University Hospital, Seoul, South Korea
  2. 2Department of Medical Law and Ethics, Graduate School, Yonsei University, Seoul, South Korea
  3. 3Blue Urology Clinic, Seoul, South Korea
  4. 4Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea
  5. 5Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea
  1. Correspondence to Dr Ho-Jin Lee, Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul 03080, South Korea; zenerdiode03{at}


Background Although there is a low incidence of complications associated with epidural injections, pain physicians should still remain vigilant for potentially serious adverse outcomes. This study aimed to identify and describe the major complications of epidural injections.

Methods This retrospective, observational, medicolegal study analyzed closed cases of precedents involving complications of epidural injections from January 1997 to August 2019 using the database of the Supreme Court of Korea’s judgement system. Clinical characteristics and judgement statuses were analyzed.

Results Of the 73 potential cases assessed for eligibility, a total of 49 malpractice cases were included in the final analysis. Thirty-three claims resulted in payments to the plaintiffs, with a median payment of US$103 828 (IQR: US$45 291–US$265 341). The most common complication was infection (n=13, 26.5%), followed by worsening pain (n=8, 16.3%). Physician malpractice before, during, and after the procedure was claimed by plaintiffs in 18 (36.7%), 44 (89.8%), and 31 (63.3%) cases, respectively. Of these cases, 6 (33.3%), 19 (43.2%), and 15 (48.4%), respectively, were adjudicated in favor of the plaintiffs by the courts. In cases involving postprocedural physician errors, the majority (13/15) of the plaintiff verdicts were related to delayed management. Violation of the physician’s duty of informed consent was claimed by plaintiffs in 31 (63.3%) cases, and 14 (45.2%) of these cases were judged medical malpractice.

Conclusions Our data will allow pain physicians to become acquainted with the major epidural injection-associated complications that underlie malpractice cases.

  • chronic pain
  • complications
  • epidural injection
  • legislation and jurisprudence
  • spinal diseases

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  • Contributors SIC: study design, statistical analysis, manuscript preparation, manuscript revision. SHS: data collection, manuscript revision. HJ: data collection, interpretation of data. JYM: manuscript revision. HJL: study design, interpretation of data, statistical analysis, manuscript preparation, manuscript revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Institutional Review Board (IRB) of Seoul National University Hospital (IRB No 1910-122-1072) approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.