The effect of sedation on the accuracy and treatment outcomes for diagnostic injections: a randomized, controlled, crossover study. Pain Med 2014 Apr;15(4):588-602
Date
02/15/2014Pubmed ID
24524866DOI
10.1111/pme.12389Scopus ID
2-s2.0-84897992830 (requires institutional sign-in at Scopus site) 29 CitationsAbstract
BACKGROUND AND OBJECTIVE: Diagnostic injections are used to diagnose myriad pain conditions, but are characterized by a high false-positive rate. One potential cause of inaccurate diagnostic blocks is the use of sedation. We sought to determine the effect of sedation on the validity of diagnostic injections.
DESIGN: Randomized, crossover study in which 73 patients were allocated to receive a diagnostic sacroiliac joint or sympathetic nerve block performed either with or without sedation using midazolam and fentanyl. Those who obtained equivocal relief, good relief lasting less than 3 months, or who were otherwise deemed good candidates for a repeat injection, received a subsequent crossover injection within 3 months (N = 46).
SETTING AND PATIENTS: A tertiary care teaching hospital and a military treatment facility.
RESULTS: In the primary crossover analysis, blocks performed with sedation resulted in a larger mean reduction in pain diary score than those done without sedation (1.2 [2.6]; P = 0.006), less procedure-related pain (difference in means 2.3 [2.5]; P < 0.0001), and a higher proportion of patients who obtained > 50% pain relief on their pain diaries (70% vs. 54%; P = 0.039). The increased pain reduction was not accompanied by increased satisfaction (sedation mean 3.9 [1.1] vs. 3.7 [1.3]; P = 0.26). Similar findings were observed for the parallel group (N = 73) and omnibus (all sedation vs. no sedation blocks, N = 110) analyses. No differences in outcomes were noted between the use and non-use of sedation at 1-month.
CONCLUSIONS: The use of sedation during diagnostic injections may increase the rate of false-positive blocks and lead to misdiagnoses and unnecessary procedures, but has no effect on satisfaction or outcomes at 1-month.
Author List
Cohen SP, Hameed H, Kurihara C, Pasquina PF, Patel AM, Babade M, Griffith SR, Erdek ME, Jamison DE, Hurley RWAuthor
Robert W. Hurley MD, PhD Adjunct Professor of Anesthesiology and CTSI in the Anesthesiology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Anesthetics, Intravenous
Autonomic Nerve Block
Complex Regional Pain Syndromes
Conscious Sedation
Cross-Over Studies
Diagnostic Techniques and Procedures
False Positive Reactions
Female
Fentanyl
Humans
Injections, Intra-Articular
Low Back Pain
Male
Midazolam
Middle Aged
Sacroiliac Joint
Treatment Outcome