Open AccessThe Effect of Sedation on the Accuracy and Treatment Outcomes for Diagnostic Injections: A Randomized, Controlled, Crossover Study
Author(s) -
Cohen Steven P.,
Hameed Haroon,
Kurihara Connie,
Pasquina Paul F.,
Patel Amit M.,
Babade Mosunmola,
Griffith Scott R.,
Erdek Michael E.,
Jamison David E.,
Hurley Robert W.
Publication year - 2014
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/pme.12389
Subject(s) - sedation , medicine , midazolam , anesthesia , fentanyl , randomized controlled trial , crossover study , surgery , alternative medicine , pathology , placebo
Abstract Background and Objective Diagnostic injections are used to diagnose myriad pain conditions, but are characterized by a high false‐positive rate. One potential cause of inaccurate diagnostic blocks is the use of sedation. We sought to determine the effect of sedation on the validity of diagnostic injections.Design Randomized, crossover study in which 73 patients were allocated to receive a diagnostic sacroiliac joint or sympathetic nerve block performed either with or without sedation using midazolam and fentanyl. Those who obtained equivocal relief, good relief lasting less than 3 months, or who were otherwise deemed good candidates for a repeat injection, received a subsequent crossover injection within 3 months (N = 46).Setting and Patients A tertiary care teaching hospital and a military treatment facility.Results In the primary crossover analysis, blocks performed with sedation resulted in a larger mean reduction in pain diary score than those done without sedation (1.2 [2.6]; P = 0.006), less procedure‐related pain (difference in means 2.3 [2.5]; P < 0.0001), and a higher proportion of patients who obtained > 50% pain relief on their pain diaries (70% vs. 54%; P = 0.039). The increased pain reduction was not accompanied by increased satisfaction (sedation mean 3.9 [1.1] vs. 3.7 [1.3]; P = 0.26). Similar findings were observed for the parallel group (N = 73) and omnibus (all sedation vs. no sedation blocks, N = 110) analyses. No differences in outcomes were noted between the use and non‐use of sedation at 1‐month.Conclusions The use of sedation during diagnostic injections may increase the rate of false‐positive blocks and lead to misdiagnoses and unnecessary procedures, but has no effect on satisfaction or outcomes at 1‐month.