Albany Medical College, Albany, NY, USA.
Pain Physician. 2013 Apr;16(2 Suppl):SE217-28.
Intravenous (IV) sedation analgesia is often employed in patients with chronic spinal pain undergoing diagnostic spinal injection procedures. The drugs used for intravenous sedation analgesia produce varying degrees of sedation, amnesia, anxiolysis, muscle relaxation, and analgesia. The very nature of these pharmacologic effects in altering the patient's level of consciousness, awareness, or response to a particular diagnostic stimulus invokes a sense of uncertainty about the results or response obtained from the diagnostic procedure. There is an ongoing controversy regarding the validity of controlled diagnostic blocks due to variability in sensitivity, specificity, and accuracy. Moreover, there is no consensus with regards to the use of sedation analgesic measures prior to controlled diagnostic blocks and their influence on the accuracy and validity of a diagnosis.
To assess and update the clinically significant effects sedation analgesia procedures have on the diagnostic accuracy and validity of interventional spinal techniques.
A comprehensive literature search using PubMed, EMBASE, and Cochrane Library review databases up to September 2012 was performed. The search included systematic and narrative review articles, prospective and retrospective studies, as well as cross-referencing of bibliographies from notable primary and review articles and abstracts from scientific meetings and peer-reviewed non-indexed journals. The search emphasized the effects of sedation analgesia on diagnostic spinal interventions.
Based on a review of the available evidence, it appears that the administration of mild to moderate sedation does not confound the results or diagnostic validity of spinal injection procedures. Specifically, immediate pain relief after cervical and lumbar facet joint controlled nerve blocks is not enhanced by IV sedation with midazolam or fentanyl. This is especially true if stringent outcome criteria are employed, such as at least 75% pain relief combined with an increase in range of motion for pain limited movements.
慢性脊柱疼痛患者在接受诊断性脊柱注射时，常采用静脉（IV）镇静镇痛。用于静脉镇静镇痛的药物可产生不同程度的镇静、遗忘、焦虑缓解、肌肉松弛和镇痛作用。这些药物改变患者意识、知觉或对特定诊断刺激的反应的药理作用本质，引起人们对诊断程序获得的结果或反应的不确定性。由于敏感性、特异性和准确性的差异，持续存在着关于控制性诊断阻滞有效性的争议。此外，对于在控制性诊断阻滞之前使用镇静镇痛措施及其对诊断准确性和有效性的影响，尚未达成共识。
评估和更新镇静镇痛程序对介入性脊柱技术诊断准确性和有效性的临床显著影响。
截至 2012 年 9 月，我们使用 PubMed、EMBASE 和 Cochrane 图书馆审查数据库进行了全面的文献检索。搜索包括系统评价和叙述性综述文章、前瞻性和回顾性研究，以及从主要和综述文章的参考文献和科学会议及同行评审非索引期刊的摘要交叉引用。搜索重点关注镇静镇痛对诊断性脊柱干预的影响。
根据现有证据的回顾，给予轻度至中度镇静似乎不会混淆脊柱注射程序的结果或诊断有效性。具体而言，静脉注射咪达唑仑或芬太尼进行中度镇静不会增强颈椎和腰椎关节突关节控制性神经阻滞后的即刻疼痛缓解。如果采用严格的结果标准，例如至少 75%的疼痛缓解伴有疼痛受限运动的活动范围增加，则更是如此。
