Gebrekristos Berkenesh, Turcu Razvan, Kotler Dana, Gureck Ashley E, Meleger Alec L
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, MA, USA.
Department of Anesthesiology, Dartmouth Medical School, Hanover, NH, USA.
Interv Pain Med. 2023 Nov 29;2(4):100371. doi: 10.1016/j.inpm.2023.100371. eCollection 2023 Dec.
INTRODUCTION: Interlaminar epidural steroid injections (ILESIs) are mainstay in the management of low back, neck and radicular pain and are a commonly performed pain management procedure in the United States. Our survey aims to provide an update in practice patterns of ILESIs among interventional pain physicians. METHODS: We distributed a 91-item survey nationwide to private and academic interventional pain physicians who perform epidural steroid injections (ESIs). The survey was distributed via REDCap with a series of questions inquiring about current practices in epidural steroid injections from March 2021 to March 2022. Cross sectional data from survey responses specific to ILESI-related practices were captured and synthesized. RESULTS: Of 103 complete survey responses, 96 physicians perform ILESIs (cervical, 87.5 %; thoracic, 82.3 %; lumbar 99 %). Nearly all surveyed physicians utilize fluoroscopy (98.1 %) over other modalities like MRI and ultrasound. For CIESIs, dexamethasone was the preferred steroid (52.4 %) over methylprednisolone (23.7 %); the converse was true for LIESIs in which methylprednisolone (44.2 %) was preferred over dexamethasone (32.6 %). The majority of providers performing ILESI's (91.7 %) preferred a Tuohy/Weiss needle while only a small fraction preferred the Quincke needle (7.2 %). Sedation practices were more varied with only about half of providers (47.6 %) offering medications. Furthermore, a great fraction of providers continue to use contrast for LIESIs (97.9 %) and CIESIs (89.6 %). DISCUSSION: Our survey suggests that despite updated consensus recommendations, variability continues to exist in procedural practice patterns. Highlighting areas of variable adherence to current safety guidelines can assist with what is emphasized in the generation of future evidence-based guidelines. Though our survey was conducted in the context of the COVID-19 pandemic with resultant supply chain shortages, more research is needed to elucidate what variables may factor into why proceduralists may stray from guideline concordant care.
引言：层间硬膜外类固醇注射（ILESIs）是治疗腰、颈和神经根性疼痛的主要方法，在美国是一种常用的疼痛管理程序。我们的调查旨在提供介入性疼痛医生中ILESIs实践模式的最新情况。 方法：我们在全国范围内向进行硬膜外类固醇注射（ESIs）的私立和学术介入性疼痛医生分发了一份包含91个项目的调查问卷。该调查通过REDCap进行分发，其中有一系列问题询问了2021年3月至2022年3月期间硬膜外类固醇注射的当前实践情况。收集并综合了针对ILESI相关实践的调查回复中的横断面数据。 结果：在103份完整的调查回复中，96名医生进行ILESIs（颈椎，87.5%；胸椎，82.3%；腰椎，99%）。几乎所有接受调查的医生都使用荧光透视法（98.1%），而不是像MRI和超声等其他方式。对于颈椎ILESIs，地塞米松是比甲泼尼龙更受青睐的类固醇（52.4%对23.7%）；而对于腰椎ILESIs则相反，甲泼尼龙（44.2%）比地塞米松（32.6%）更受青睐。大多数进行ILESIs的提供者（91.7%）更喜欢使用Tuohy/Weiss针，而只有一小部分人更喜欢使用Quincke针（7.2%）。镇静实践差异更大，只有约一半的提供者（47.6%）提供药物。此外，很大一部分提供者在腰椎ILESIs（97.9%）和颈椎ILESIs（89.6%）中继续使用造影剂。 讨论：我们的调查表明，尽管有更新的共识建议，但程序实践模式中仍存在差异。突出对当前安全指南的不同遵循领域，有助于在未来基于证据的指南制定中强调重点。尽管我们的调查是在COVID-19大流行以及由此导致的供应链短缺背景下进行的，但仍需要更多研究来阐明哪些变量可能导致操作医生偏离指南一致的护理。
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