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Gadolinium use for interventional pain procedures: where we are and where we are heading
  1. Shravani Durbhakula1 and
  2. Steven P Cohen2,3
  1. 1 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  2. 2 Departments of Anesthesiology and Critical Care Medicine; Neurology; and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  3. 3 Departments of Anesthesiology and Physical Medicine & Rehabilitation, Uniformed Services, University of the Health Sciences, Bethesda, Maryland, USA
  1. Correspondence to Dr Steven P Cohen, Departments of Anesthesiology and Critical Care Medicine; Neurology; and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; scohen40{at}jhmi.edu

Abstract

In recent years as the use of interventional pain procedures has soared, so too has outside and internal scrutiny. This scrutiny includes agreater emphasis on weighing the risks and benefits of procedures, increased surveillance for adverse events, and cost containment strategies. In 2016, the first reports of gadolinium deposition in the central nervous system began to surface, though retention in other organ systems has been appreciated for over a decade. In this issue of Regional Anesthesia & Pain Medicine, Benzon et al. report a series of patients with document edhypersensitivity reactions to iodinated contrast medium who were inadvertently administered iodine-based contrast without adverse consequences. In this article, we discuss the epidemiology of contrast-mediated adverse effects, the mechanistic basis for hypersensitivity reactions, the risks and benefits of various approaches in the patient with a documented contrast hypersensitivity reaction, and risk mitigation strategies.

  • interventional pain management
  • chronic pain: imaging
  • pain medicine

https://doi.org/10.1136/rapm-2018-100163

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    Footnotes

    • Contributors SPC provided concept generation. Both authors wrote the article and critically reviewed the content.

    • Funding SPC is funded in part by a Congressional grant from the Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD (SAP grant 111726).

    • Disclaimer The views expressed in this manuscript are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or U.S. Government. The identification of specific products is considered an integral part of the scientific endeavor and does not constitute endorsement or implied endorsement on the part of the author, DoD, or any component agency

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.

    • Data sharing statement No additional data are available.