At the 12th Annual Spine, Orthopedic and Paine Management-Driven ASC Conference in Chicago on June 13, Timothy Maus, MD, an associate professor of radiology at Rochester, Minn.-based Mayo Clinic, discussed sedation to manage pain during interventional spine procedures.
"Unfortunately, there's an incredible variety of utilization, from uniform use to never or rarely," Dr. Maus said of sedation. He reviewed various studies to evaluate whether or not sedation should be used routinely. Here are three key findings he shared during his presentation on the use of sedation during interventional spine procedures.
1. Routine sedation doesn't seem to be necessary before spinal injections. A study published in Spine in 2006 examined a case series of 500 consecutive patients receiving facet or epidural injections. Seventeen percent requested sedation, and 28 percent would ask for a second injection. Those requesting a second injection had a higher pain rate during the procedure. Overall, the study concluded routine sedation before diagnostic and therapeutic spine injections isn't needed.
A 2007 study, also published in Spine, found 93 percent of patients who decided not to receive sedation during a spinal injection were satisfied with the procedure, while just 1.5 percent reported wishing they had chosen sedation. Therefore, the study concluded routine sedation doesn't seem to be necessary for spinal injections.
2. Moderate sedation could be beneficial if the patient had a prior vasovagal reaction. A 2013 International Spine Intervention Society study of 6,364 consecutive spine procedures found that of the 134 repeat injections performed on patients with a history of vasovagal reaction, 23 percent of those without sedation had a repeat reaction, compared with none of those who received moderate sedation.
3. Sedation has small but real risks. Two case reports published in Spine in 1998 on cervical epidural steroid injection with intrinsic spinal cord damage found there were probable direct cord penetrations due to lack of patient responsiveness under sedation, as well as a risk of permanent neurologic injuries. Overall, the study recommended against IV sedation during epidural injections. Other potential risks and complications identified in various studies and research include cord infarction/stroke, airway compromise, arrhythmia, hypotension, venous thrombosis, pulmonary embolism and protracted nausea or vomiting.
Ultimately, based on the research reviewed, Dr. Maus concluded sedation for interventional spine procedures isn't necessary in most cases and shouldn't be used routinely.
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