Very few reports of complications are found in the literature. The risk of infection or bleeding appears to be very rare. There is also a risk of allergic reaction to the contrast or medication. Corticosteroids will elevate serum blood sugars in the diabetic patient. Some patients will experience short-term side effects from the steroid including insomnia, an increased appetite, and headache. Pain exacerbation should also be considered a very rare event. The risk of a dural puncture is present, mainly with a puncture into the medial aspect of the foramen or in a patient with dural ectasia. This is most commonly seen on the sacral segments. This could precipitate a spinal headache. The cervical SNRB has the additional risk of puncture of the vertebral artery, which can result in dissection

Dural Ectasia Cervical SpineWhere Costovertebral Area PicturesThoracic Snrb
Fig. 10. Thoracic SNRB with a contrast epineurogram. Note the close proximity of the pleural reflection. The costovertebral junction borders the target area anteriorly.

or occlusion. The epidural spread of medication at the cervical level can at least theoretically result in intraspinal medication because of the small risk of epidural to intradural communication. This could result in a risk of temporary spinal anesthesia. This complication is more frequently seen, although also rare, with cervical epidural injections. There is also the devastating risk of inadvertent injection of medications intracranially with an unrec-

Picture S1foramen
Fig. 11. Sacral SNRB accessing the S1 foramen.

ognized vertebral artery puncture. The thoracic nerve block carries the additional risk of pleural puncture and an associated pneumothorax.

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