What is the dosage used for epidural steroid injections (ESIs)?

Updated: Aug 06, 2018
  • Author: Boqing Chen, MD, PhD; Chief Editor: Stephen Kishner, MD, MHA  more...
  • Print
Answer

Answer

Studies have suggested that depending on the particular clinical scenario, the total dose of methylprednisolone should probably not exceed approximately 3 mg/kg of body weight, in order to prevent excessive salt and water retention. A study of methylprednisolone dosage in patients with chronic lower back pain found that a 40-mg dose is just as effective as an 80-mg dose in improving disability. The lower dose should be considered for patients who receive repeat injections. [29] For interlaminar ESIs, the typical corticosteroid doses are 12-18 mg for betamethasone and 80-120 mg for methylprednisolone. Half of these steroid doses are generally used when performing transforaminal ESIs. The epidural steroid is injected in a diluent, such as lidocaine (1-2%) and/or normal saline.

The volume of the injectate is dictated mainly by the approach used. In cervical and thoracic epidural injections, a total of 3-5 mL may be used for ESIs using the interlaminar approach. However, in cervical and thoracic transforaminal ESIs, clinicians generally use a total volume of only about 1.5-2 mL. The volume used for lumbar ESIs is slightly greater, generally being 6-10 mL for interlaminar ESIs, up to 20 mL for caudal ESIs, and 3-4 mL for transforaminal ESIs.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!