Epidural Shortages Impacting Pain Management Worldwide

By Pat Anson, PNN Editor

Global shortages of epidural catheters and contrast dye used in medical imaging are forcing some healthcare providers to ration or postpone epidural procedures, which are commonly used to relieve back pain, labor pain and as spinal anesthesia for some surgeries.

At present, most of the catheter shortages are being reported by hospitals in Canada, with anecdotal reports of shortages in the United States. Epidural catheters are thin plastic tubes that are inserted into the lower back by a needle to allow physicians to deliver steroids and other pain medications to the spinal area.

Health Canada last week added Flex-Tip epidural catheterization kits to its list of medical device shortages. The shortage began on July 18 and is expected to continue until the end of the year. The epidural kits are made by Arrow International of Pennsylvania, which did not respond to a PNN request for comment.

The Vice-President of the Canadian Anesthesiologists’ Society said most of the shortages are in western Canada, and that healthcare providers are frustrated by a lack of information from catheter manufacturers and Health Canada.

“If the shortage is global, maybe it wouldn’t make a difference. But I do think that on the communication side, on the supply-chain side and the protocols that exist, there’s room for improvement,” Dr. Lucie Filteau told The Canadian Press. “We thought there were just isolated little pockets, and people started to become aware that it was more widespread.”

In May, an international supplier of epidural kits in the UK announced a disruption to its supply due to shortages of a blue dye used in tubing. The disruption was projected to last until July, but appears to be ongoing. Australia’s Therapeutic Goods Administration recently issued an alert warning of “temporary supply issues affecting popular brands of epidural kits in overseas markets.”

“We have anecdotally heard of shortages,” a spokesperson for the American Society of Anesthesiologists told PNN when asked about catheter shortages in the U.S. The organization was planning to survey its members to get a better idea of the extent of the problem. The U.S. Food and Drug Administration does not currently have epidural catheters on its list of medical device shortages.

Epidurals are widely used in the U.S. and Canada to relieve pain during labor and cesarean sections. The injections numb the lower part of the body, allowing expectant mothers to remain awake during child birth. Nitrous oxide – more commonly known as laughing gas – can be used as an alternative to epidurals.

In addition to treating labor pain, epidural injections are widely used for back pain. About 9 million epidural steroid injections are performed annually in the U.S., even though they are not FDA-approved. The FDA has warned that injection of steroids into the epidural space can result in rare but serious neurological problems, including loss of vision, stroke and paralysis.

Meanwhile, a global shortage of contrast dyes that began in April due to COVID-related supply chain disruptions in China appears to be easing. Contrast dyes — also known as imaging agents — play a vital role in epidural procedures because they help providers “see” where a needle is being placed. Even a minor mistake could lead to permanent damage to the spinal cord.

Australian health officials said last week the supply of imaging agents was improving, but that normal supplies are “not likely to resume before the end of 2022.” They urged providers to continue conserving contrast agents and to postpone imaging that was not urgent.