Pain medicine (Malden, Mass.) · 2013
Vasovagal rates in flouroscopically guided interventional procedures: a study of over 8,000 injections.
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Kennedy David J, Schneider Byron, Casey Ellen, Rittenberg Joshua, Conrad Bryan, Smuck Matthew, Plastaras Christopher T
Аннотация
OBJECTIVE: To determine the rate of vasovagal (vv) complications in fluoroscopically guided interventional procedures.
DESIGN: Retrospective case series analysis of prospectively collected data from March 8, 2004 to January 30, 2009.
SETTING: A single academic medical center.
SUBJECTS: Four thousand one hundred eighty-three subjects undergoing 8,010 consecutive injections.
OUTCOME MEASURES: Pearson's chi-square test was used to determine the relationship between categorical variables.
RESULTS: A total of 8,010 injections, including epidural steroid injections, radiofrequency nerve ablations, medial branch blocks, hip injections, knee injections, and glenohumeral injections were performed. Overall vv reaction rate was 2.6%, with 0.8% of procedures resulting in early terminated due to vv reaction. Peripheral joint injections had a vv rate of 0.2%, all occurring in hip injections. Transforaminal epidural steroid injections had a vv rate of 3.5%. Diagnostic blocks of the medial branches had the highest rate of vv (5.1%). Other predictors of vv reactions were identified including preprocedure pain score visual analog scale <5 (P = 0.004), male gender (P < 0.001), and age less than 65 years old (P < 0.001).
CONCLUSIONS: vv reactions have an overall low occurrence rate (2.6%) in interventional procedures ranging from 0% in peripheral knee and shoulder injections to 5.1% in medial branch blocks. Conservative treatment of vv reaction and willingness to terminate procedures resulted in no serious adverse events related to vv reaction in 8,010 procedures.
DESIGN: Retrospective case series analysis of prospectively collected data from March 8, 2004 to January 30, 2009.
SETTING: A single academic medical center.
SUBJECTS: Four thousand one hundred eighty-three subjects undergoing 8,010 consecutive injections.
OUTCOME MEASURES: Pearson's chi-square test was used to determine the relationship between categorical variables.
RESULTS: A total of 8,010 injections, including epidural steroid injections, radiofrequency nerve ablations, medial branch blocks, hip injections, knee injections, and glenohumeral injections were performed. Overall vv reaction rate was 2.6%, with 0.8% of procedures resulting in early terminated due to vv reaction. Peripheral joint injections had a vv rate of 0.2%, all occurring in hip injections. Transforaminal epidural steroid injections had a vv rate of 3.5%. Diagnostic blocks of the medial branches had the highest rate of vv (5.1%). Other predictors of vv reactions were identified including preprocedure pain score visual analog scale <5 (P = 0.004), male gender (P < 0.001), and age less than 65 years old (P < 0.001).
CONCLUSIONS: vv reactions have an overall low occurrence rate (2.6%) in interventional procedures ranging from 0% in peripheral knee and shoulder injections to 5.1% in medial branch blocks. Conservative treatment of vv reaction and willingness to terminate procedures resulted in no serious adverse events related to vv reaction in 8,010 procedures.