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Review
. 2021 Aug 1;133(2):535-552.
doi: 10.1213/ANE.0000000000005443.

The Use of Contrast Agents in Interventional Pain Procedures: A Multispecialty and Multisociety Practice Advisory on Nephrogenic Systemic Fibrosis, Gadolinium Deposition in the Brain, Encephalopathy After Unintentional Intrathecal Gadolinium Injection, and Hypersensitivity Reactions

Honorio T Benzon  1 , Timothy P Maus  2 , Hye-Ryun Kang  3 , David A Provenzano  4 , Anuj Bhatia  5 , Felix Diehn  2 , Ariana Nelson  6 , Zachary L McCormick  7 , Benjamin P Liu  8 , Javier de Andres Ares  9 , Magdalena Anitescu  10 , Kristine Blackham  11 , Arun Bhaskar  12 , Silviu Brill  13 , Jeremy Collins  2 , Ashish Gulve  14 , Robert W Hurley  15 , Young Hoon Jeon  16 , Jee Youn Moon  17 , Richard L Rauck  18 , Meghan Rodes  1 , Ryan K Lee  19 , Vinil Shah  20 , Harsha Shanthanna  21 , Jan van Zundert  22 , Marc Huntoon  23 , James P Rathmell  24 , Mario Sanchez Borges  25 , Steven P Cohen  26 , Paul A Greenberger  27
Affiliations
Review

The Use of Contrast Agents in Interventional Pain Procedures: A Multispecialty and Multisociety Practice Advisory on Nephrogenic Systemic Fibrosis, Gadolinium Deposition in the Brain, Encephalopathy After Unintentional Intrathecal Gadolinium Injection, and Hypersensitivity Reactions

Honorio T Benzon et al. Anesth Analg. .

Abstract

This Practice Advisory presents a comprehensive and evidence-based set of position statements and recommendations for the use of contrast media in interventional pain procedures. The advisory was established by an international panel of experts under the auspices of 11 multinational and multispecialty organizations based on a comprehensive review of the literature up to December 31, 2019. The advisory discusses the risks of using gadolinium-based contrast agents. These include nephrogenic systemic fibrosis, gadolinium brain deposition/retention, and encephalopathy and death after an unintentional intrathecal gadolinium injection. The advisory provides recommendations on the selection of a specific gadolinium-based contrast agent in patients with renal insufficiency, those who had multiple gadolinium-enhanced magnetic resonance imaging examinations, and in cases of paraspinal injections. Additionally, recommendations are made for patients who have a history of mild, moderate, or severe hypersensitivity reactions to contrast medium.

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Conflict of interest statement

Conflicts of Interest: See Disclosures at the end of the article.

References

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