Impact of sedation on patient satisfaction, radiation exposure, and complications in lumbar transforaminal epidural steroid injections: A retrospective cohort study.

BACKGROUND

This study aims to investigate whether moderate sedation (MOAA/S 3-4) affects procedural efficiency, radiation exposure, patient-physician satisfaction, and clinical outcomes during lumbar transforaminal epidural steroid injections (L-TFESI).

PATIENTS AND

METHODS

Between January 2021 and January 2024, a total of 201 patients with unilateral, single-root compression who underwent L-TFESI either with (Group S, n = 99) or without sedation (Group NS, n = 102) were retrospectively analyzed. In the sedation group, midazolam and fentanyl were titrated to a target Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score of 3-4. The primary outcomes were cumulative radiation dose (mGy), fluoroscopy time, and procedural complications. Additional outcomes included Numeric Rating Scale-11 (NRS-11) scores (baseline, Day 4, Week 4) and Likert satisfaction scales.

RESULTS

Of a total of 201 patients, 143 were male and 58 were female with a mean age of 47.22 ± 10.03 (range, 22 to 65) years. Both groups were comparable in terms of baseline demographics and pain scores. The sedation group had significantly lower cumulative radiation exposure (3.92 ± 0.30 mGy vs. 4.31 ± 0.40 mGy) and shorter fluoroscopy times (28.13 ± 2.79 sec vs. 33.13 ± 3.95 sec). Minor procedural complications (commonly vasovagal reactions and hypertension) were more frequent in the non-sedated group (21.6% vs. 2.0%). Group S reported lower pain scores on Day 4 (1.11 ± 1.29 vs. 1.88 ± 1.25), although outcomes were similar at Week 4. Patient and physician satisfaction were higher in the sedation group.

CONCLUSION

Moderate sedation (MOAA/S 3-4) during L-TFESI is associated with lower radiation exposure, shorter procedure times and fewer minor complications, while improving both patient satisfaction and procedural conditions. These findings suggest that sedation is a potentially useful adjunct in selected patients that may contribute to improved procedural quality in interventional pain management.