美国介入性疼痛管理医师行硬膜外腔间注射的实践模式的差异。
Variations in Interlaminar Epidural Steroid Injection Practice Patterns by Interventional Pain Management Physicians in the United States.
机构信息
Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Langone Health, New York, NY.
出版信息
Pain Physician. 2018 Sep;21(5):E493-E499.
BACKGROUND
Previous surveys have identified variations in practice patterns related to epidural steroid injections. Since then, the United States Food and Drug Administration (FDA) has required the addition of drug warning labels for injectable corticosteroids. Updated evidence, as well as scrutiny from regulatory agencies, may affect practice patterns.
OBJECTIVE
To provide an update on interlaminar epidural steroid injection (ILESI) practice patterns, we surveyed interventional pain management (IPM) physicians in the United States.
STUDY DESIGN AND SETTING
This was a cross-sectional survey of IPM physicians in the United States.
METHODS
A web-based survey was distributed to IPM physicians in the United States selected from the Accreditation Council for Graduate Medical Education accredited pain medicine fellowship program list as well as the American Society of Interventional Pain Physicians membership database. Physicians were queried about ILESI practices, including needle size, use of image guidance, level of injection, identification of the epidural space, and preference for injectate.
RESULTS
A total of 249 responses were analyzed. All respondents used image guidance for ILESI. There were variations in needle size, use of contrast, number of fluoroscopic views utilized, technique for identifying the epidural space, and choice of injectate.
LIMITATIONS
The response rate is a limitation, thus the results may not be representative of all United States IPM physicians.
CONCLUSIONS
Though all respondents used image guidance for ILESI, variations in other ILESI practices still exist. Since the closure of this survey, a multi-society pain workgroup published recommendations regarding ESI practices. Our survey findings support the need for more evidence-based guidelines regarding ESI.
KEY WORDS
Epidural injection, epidural steroids, survey, low back pain, neck pain, technique.
背景
先前的调查已经确定了与硬膜外类固醇注射相关的实践模式的变化。此后，美国食品和药物管理局 (FDA) 要求在可注射皮质类固醇的药物警告标签上添加说明。更新的证据以及监管机构的审查可能会影响实践模式。
目的
提供有关经椎间孔硬膜外类固醇注射 (ILESI) 实践模式的最新信息，我们对美国的介入性疼痛管理 (IPM) 医生进行了调查。
研究设计和设置
这是一项针对美国 IPM 医生的横断面调查。
方法
通过美国疼痛医学研究生医学教育认证委员会认可的疼痛医学研究员计划名单以及美国介入性疼痛医师学会的会员数据库，向美国的 IPM 医生在线分发了一项调查。医生被询问关于 ILESI 的实践，包括针头大小、使用影像引导、注射水平、硬膜外间隙的识别以及注射剂的偏好。
结果
共分析了 249 份回复。所有受访者都使用影像引导进行 ILESI。在针头大小、使用对比剂、透视视图数量、识别硬膜外间隙的技术以及注射剂的选择方面存在差异。
局限性
回复率是一个限制，因此结果可能不能代表所有美国 IPM 医生。
结论
尽管所有受访者都使用影像引导进行 ILESI，但 ILESI 其他实践仍存在差异。自这项调查结束以来，一个多协会疼痛工作组发布了有关 ESI 实践的建议。我们的调查结果支持需要更多关于 ESI 的基于证据的指南。
关键词
硬膜外注射、硬膜外类固醇、调查、下腰痛、颈痛、技术。
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