An Audit of transforaminal epidural steroid injections without sedation: Low patient dissatisfaction and low vasovagal rates

Felix E. Diehn, Jennifer R. Geske, Kimberly K. Amrami, Timothy J Kaufmann, Jonathan M. Morris, Naveen S Murthy, Kent R. Thielen, John T. Wald, Randy A. Shelerud, Rickey E. Carter, Timothy Maus

Research output: Contribution to journalArticle

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Abstract

Objective: To assess frequency of sedation in transforaminal epidural steroid injections (TFESI) and to analyze patient dissatisfaction and vasovagal rates. Design: Retrospective audit over a 6-year period, January 1, 2006-December 31, 2011. Setting: Single academic center radiology pain management practice. Subjects: Four thousand four hundred thirty-two patients undergoing 6,878 consecutive TFESI. Outcome Measures: Frequency of sedation for TFESI was assessed. Vasovagal and patient dissatisfaction rates were assessed, the latter by patients' responses to two follow-up survey questions at 2 weeks postprocedure. Results: Six thousand eight hundred seventy-eight TFESI were performed, of which only 0.1% (N=7) were performed with sedation. Only 0.4% (N=28) of TFESI were complicated by vasovagal reaction. Seventy-two percent (N=4,980) of nonsedated patients responded to the survey. Overall medical care in the nonsedated was rated as: excellent 51%, very good 30%, good 15%, fair 3%, and poor 1%. Ninety-five percent confidence interval (CI) for the 3.9% of the nonsedated patients who rated their care at best "fair" was (3.3, 4.4%). Likelihood of referring friends/family members in nonsedated patients was: definitely 53%, probably 28%, uncertain 16%, probably not 3%, definitely not 0.2%. Ninety-five percent CI for the 3.2% of the nonsedated patients who would at best "probably not refer" their friends/family was (2.7, 3.7%). Conclusions: In our radiology pain management practice, sedation was rarely utilized for TFESI. A small minority of nonsedated patients rated their care at best fair and would at best probably not refer friends/family members. TFESI can be performed without sedation with low patient dissatisfaction and low vasovagal rates.

Original languageEnglish (US)
Pages (from-to)994-998
Number of pages5
JournalPain Medicine (United States)
Volume14
Issue number7
DOIs
StatePublished - Jul 2013

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Epidural Injections
Steroids
Pain Management
Radiology
Confidence Intervals
Outcome Assessment (Health Care)

Keywords

  • Epidural Steroid
  • Patient Satisfaction
  • Sedation
  • TFESI
  • Transforaminal

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

An Audit of transforaminal epidural steroid injections without sedation : Low patient dissatisfaction and low vasovagal rates. / Diehn, Felix E.; Geske, Jennifer R.; Amrami, Kimberly K.; Kaufmann, Timothy J; Morris, Jonathan M.; Murthy, Naveen S; Thielen, Kent R.; Wald, John T.; Shelerud, Randy A.; Carter, Rickey E.; Maus, Timothy.

In: Pain Medicine (United States), Vol. 14, No. 7, 07.2013, p. 994-998.

Research output: Contribution to journalArticle

Diehn, Felix E. ; Geske, Jennifer R. ; Amrami, Kimberly K. ; Kaufmann, Timothy J ; Morris, Jonathan M. ; Murthy, Naveen S ; Thielen, Kent R. ; Wald, John T. ; Shelerud, Randy A. ; Carter, Rickey E. ; Maus, Timothy. / An Audit of transforaminal epidural steroid injections without sedation : Low patient dissatisfaction and low vasovagal rates. In: Pain Medicine (United States). 2013 ; Vol. 14, No. 7. pp. 994-998.
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abstract = "Objective: To assess frequency of sedation in transforaminal epidural steroid injections (TFESI) and to analyze patient dissatisfaction and vasovagal rates. Design: Retrospective audit over a 6-year period, January 1, 2006-December 31, 2011. Setting: Single academic center radiology pain management practice. Subjects: Four thousand four hundred thirty-two patients undergoing 6,878 consecutive TFESI. Outcome Measures: Frequency of sedation for TFESI was assessed. Vasovagal and patient dissatisfaction rates were assessed, the latter by patients' responses to two follow-up survey questions at 2 weeks postprocedure. Results: Six thousand eight hundred seventy-eight TFESI were performed, of which only 0.1{\%} (N=7) were performed with sedation. Only 0.4{\%} (N=28) of TFESI were complicated by vasovagal reaction. Seventy-two percent (N=4,980) of nonsedated patients responded to the survey. Overall medical care in the nonsedated was rated as: excellent 51{\%}, very good 30{\%}, good 15{\%}, fair 3{\%}, and poor 1{\%}. Ninety-five percent confidence interval (CI) for the 3.9{\%} of the nonsedated patients who rated their care at best {"}fair{"} was (3.3, 4.4{\%}). Likelihood of referring friends/family members in nonsedated patients was: definitely 53{\%}, probably 28{\%}, uncertain 16{\%}, probably not 3{\%}, definitely not 0.2{\%}. Ninety-five percent CI for the 3.2{\%} of the nonsedated patients who would at best {"}probably not refer{"} their friends/family was (2.7, 3.7{\%}). Conclusions: In our radiology pain management practice, sedation was rarely utilized for TFESI. A small minority of nonsedated patients rated their care at best fair and would at best probably not refer friends/family members. TFESI can be performed without sedation with low patient dissatisfaction and low vasovagal rates.",
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AU - Kaufmann, Timothy J

AU - Morris, Jonathan M.

AU - Murthy, Naveen S

AU - Thielen, Kent R.

AU - Wald, John T.

AU - Shelerud, Randy A.

AU - Carter, Rickey E.

AU - Maus, Timothy

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N2 - Objective: To assess frequency of sedation in transforaminal epidural steroid injections (TFESI) and to analyze patient dissatisfaction and vasovagal rates. Design: Retrospective audit over a 6-year period, January 1, 2006-December 31, 2011. Setting: Single academic center radiology pain management practice. Subjects: Four thousand four hundred thirty-two patients undergoing 6,878 consecutive TFESI. Outcome Measures: Frequency of sedation for TFESI was assessed. Vasovagal and patient dissatisfaction rates were assessed, the latter by patients' responses to two follow-up survey questions at 2 weeks postprocedure. Results: Six thousand eight hundred seventy-eight TFESI were performed, of which only 0.1% (N=7) were performed with sedation. Only 0.4% (N=28) of TFESI were complicated by vasovagal reaction. Seventy-two percent (N=4,980) of nonsedated patients responded to the survey. Overall medical care in the nonsedated was rated as: excellent 51%, very good 30%, good 15%, fair 3%, and poor 1%. Ninety-five percent confidence interval (CI) for the 3.9% of the nonsedated patients who rated their care at best "fair" was (3.3, 4.4%). Likelihood of referring friends/family members in nonsedated patients was: definitely 53%, probably 28%, uncertain 16%, probably not 3%, definitely not 0.2%. Ninety-five percent CI for the 3.2% of the nonsedated patients who would at best "probably not refer" their friends/family was (2.7, 3.7%). Conclusions: In our radiology pain management practice, sedation was rarely utilized for TFESI. A small minority of nonsedated patients rated their care at best fair and would at best probably not refer friends/family members. TFESI can be performed without sedation with low patient dissatisfaction and low vasovagal rates.

AB - Objective: To assess frequency of sedation in transforaminal epidural steroid injections (TFESI) and to analyze patient dissatisfaction and vasovagal rates. Design: Retrospective audit over a 6-year period, January 1, 2006-December 31, 2011. Setting: Single academic center radiology pain management practice. Subjects: Four thousand four hundred thirty-two patients undergoing 6,878 consecutive TFESI. Outcome Measures: Frequency of sedation for TFESI was assessed. Vasovagal and patient dissatisfaction rates were assessed, the latter by patients' responses to two follow-up survey questions at 2 weeks postprocedure. Results: Six thousand eight hundred seventy-eight TFESI were performed, of which only 0.1% (N=7) were performed with sedation. Only 0.4% (N=28) of TFESI were complicated by vasovagal reaction. Seventy-two percent (N=4,980) of nonsedated patients responded to the survey. Overall medical care in the nonsedated was rated as: excellent 51%, very good 30%, good 15%, fair 3%, and poor 1%. Ninety-five percent confidence interval (CI) for the 3.9% of the nonsedated patients who rated their care at best "fair" was (3.3, 4.4%). Likelihood of referring friends/family members in nonsedated patients was: definitely 53%, probably 28%, uncertain 16%, probably not 3%, definitely not 0.2%. Ninety-five percent CI for the 3.2% of the nonsedated patients who would at best "probably not refer" their friends/family was (2.7, 3.7%). Conclusions: In our radiology pain management practice, sedation was rarely utilized for TFESI. A small minority of nonsedated patients rated their care at best fair and would at best probably not refer friends/family members. TFESI can be performed without sedation with low patient dissatisfaction and low vasovagal rates.

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