Open AccessAn Update of Evaluation of Intravenous Sedation on Diagnostic Spinal Injection Procedures
Author(s) -
Howard S. Smith,
James Colson,
Nalini Sehgal
Publication year - 2013
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2013/16/se217
Subject(s) - medicine , sedation , anesthesia , medline , cochrane library , intensive care medicine , randomized controlled trial , surgery , political science , law
Background: Intravenous (IV) sedation analgesia is often employed in patients with chronicspinal pain undergoing diagnostic spinal injection procedures. The drugs used for intravenoussedation analgesia produce varying degrees of sedation, amnesia, anxiolysis, muscle relaxation,and analgesia. The very nature of these pharmacologic effects in altering the patient’s level ofconsciousness, awareness, or response to a particular diagnostic stimulus invokes a sense ofuncertainty about the results or response obtained from the diagnostic procedure. There is anongoing controversy regarding the validity of controlled diagnostic blocks due to variability insensitivity, specificity, and accuracy. Moreover, there is no consensus with regards to the useof sedation analgesic measures prior to controlled diagnostic blocks and their influence on theaccuracy and validity of a diagnosis.Objective: To assess and update the clinically significant effects sedation analgesia procedureshave on the diagnostic accuracy and validity of interventional spinal techniques.Methods: A comprehensive literature search using PubMed, EMBASE, and Cochrane Libraryreview databases up to September 2012 was performed. The search included systematic andnarrative review articles, prospective and retrospective studies, as well as cross-referencing ofbibliographies from notable primary and review articles and abstracts from scientific meetingsand peer-reviewed non-indexed journals. The search emphasized the effects of sedationanalgesia on diagnostic spinal interventions.Conclusion: Based on a review of the available evidence, it appears that the administrationof mild to moderate sedation does not confound the results or diagnostic validity of spinalinjection procedures. Specifically, immediate pain relief after cervical and lumbar facet jointcontrolled nerve blocks is not enhanced by IV sedation with midazolam or fentanyl. This isespecially true if stringent outcome criteria are employed, such as at least 75% pain reliefcombined with an increase in range of motion for pain limited movements.Key words: Conscious sedation, procedural sedation, intravenous sedation, analgesia,hypnotics, sedatives, anxiolytics, opioids, chronic spinal pain, spinal injections, epiduralinjections, controlled diagnostic nerve blocks, zygapophyseal or facet joint blocks, selectivenerve root blocks, provocation discography, sacroiliac joint injections, outcomes