An audit of transforaminal epidural steroid injections without sedation: low patient dissatisfaction and low vasovagal rates.

OBJECTIVE

To assess frequency of sedation in transforaminal epidural steroid injections (TFESI) and to analyze patient dissatisfaction and vasovagal rates.

DESIGN

Retrospective audit over a 6-year period, January 1, 2006-December 31, 2011.

SETTING

Single academic center radiology pain management practice.

SUBJECTS

Four thousand four hundred thirty-two patients undergoing 6,878 consecutive TFESI.

OUTCOME MEASURES

Frequency of sedation for TFESI was assessed. Vasovagal and patient dissatisfaction rates were assessed, the latter by patients' responses to two follow-up survey questions at 2 weeks postprocedure.

RESULTS

Six thousand eight hundred seventy-eight TFESI were performed, of which only 0.1% (N = 7) were performed with sedation. Only 0.4% (N = 28) of TFESI were complicated by vasovagal reaction. Seventy-two percent (N = 4,980) of nonsedated patients responded to the survey. Overall medical care in the nonsedated was rated as: excellent 51%, very good 30%, good 15%, fair 3%, and poor 1%. Ninety-five percent confidence interval (CI) for the 3.9% of the nonsedated patients who rated their care at best "fair" was (3.3, 4.4%). Likelihood of referring friends/family members in nonsedated patients was: definitely 53%, probably 28%, uncertain 16%, probably not 3%, definitely not 0.2%. Ninety-five percent CI for the 3.2% of the nonsedated patients who would at best "probably not refer" their friends/family was (2.7, 3.7%).

CONCLUSIONS

In our radiology pain management practice, sedation was rarely utilized for TFESI. A small minority of nonsedated patients rated their care at best fair and would at best probably not refer friends/family members. TFESI can be performed without sedation with low patient dissatisfaction and low vasovagal rates.