Open AccessVariations of Technique in Transforaminal Epidural Steroid Injections and Periprocedural Practices by Interventional Pain Medicine Physicians in the United States
Author(s) -
Lisa Doan
Publication year - 2019
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/2019.22.e435
Subject(s) - medicine , accreditation , graduate medical education , scrutiny , family medicine , epidural steroid injection , pain medicine , medline , alternative medicine , anesthesiology , emergency medicine , anesthesia , low back pain , medical education , pathology , political science , law
Background: Interlaminar and transforaminal epidural steroid injections (ILESI and TFESI) arecommonly performed procedures. However, the United States Food and Drug Administration hasrequired the addition of drug warning labels for injectable corticosteroids. Updated evidence andscrutiny from regulatory agencies may affect practice patterns.Objective: To characterize TFESI practices as well as to provide an update on periproceduralpractices for any type of epidural steroid injection (ESI), we surveyed pain medicine physicians inthe United States.Study Design and Setting: This was a cross-sectional survey of pain medicine physicians inthe United States.Methods: A web-based survey was distributed to pain medicine physicians in the UnitedStates selected from the Accreditation Council for Graduate Medical Education accredited painmedicine fellowship program list as well as the American Society of Interventional Pain Physiciansmembership database. Physicians were queried about TFESI practices, including needle size, use ofimage guidance, methods to detect vascular uptake, and preference for injectate.Results: A total of 249 responses were analyzed. Only a minority of respondents reportedperforming cervical TFESI. There were variations in needle size, methods to detect vascular uptake,and choice of injectate. There were also variations in monitoring practices.Limitations: The response rate is a limitation. Thus the results may not be representative of allUS pain medicine physicians.Conclusions: Though all respondents used image guidance for TFESI, variations in other TFESIpractices exist. There are also differences in periprocedural practices. Since the closure of thissurvey, a multisociety pain workgroup published recommendations regarding ESI practices. Oursurvey findings support the need for more evidence-based guidelines regarding ESI.Key words: Epidural steroid injections, transforaminal epidural steroid injection, steroids, localanesthetic, survey, interventional pain