Immediate adverse events in interventional pain procedures: A multi-institutional study

Carrie Carr, Christopher T. Plastaras, Matthew J. Pingree, Matthew Smuck, Timothy Maus, Jennifer R. Geske, Christine A. El-Yahchouchi, Zachary L. McCormick, David J. Kennedy

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Setting. Interventional procedures directed toward sources of pain in the axial and appendicular musculoskeletal system are performed with increasing frequency. Despite the presence of evidence- based guidelines for such procedures, there are wide variations in practice. Case reports of serious complications such as spinal cord infarction or infection from spine injections lack appropriate context and create a misleading view of the risks of appropriately performed interventional pain procedures. Objective. To evaluate adverse event rate for interventional spine procedures performed at three academic interventional spine practices. Methods. Quality assurance databases at three academic interventional pain management practices that utilize evidence-based guidelines [1] were interrogated for immediate complications from interventional pain procedures. Review of the electronic medical record verified or refuted the occurrence of a complication. Same-day emergency department transfers or visits were also identified by a records search. Results. Immediate complication data were available for 26,061 consecutive procedures. A radiology practice performed 19,170 epidural steroid (primarily transforaminal), facet, sacroiliac, and trigger point injections (2006-2013). A physiatry practice performed 6,190 spine interventions (2004-2009). A second physiatry practice performed 701 spine procedures (2009-2010). There were no major complications (permanent neurologic deficit or clinically significant bleeding [e.g., epidural hematoma]) with any procedure. Overall complication rate was 1.9% (493/26,061). Vasovagal reactions were the most frequent event (1.1%). Nineteen patients ( < 0.1%) were transferred to emergency departments for: allergic reactions, chest pain, symptomatic hypertension, and a vasovagal reaction. Conclusion. This study demonstrates that interventional pain procedures are safely performed with extremely low immediate adverse event rates when evidence-based guidelines are observed.

Original languageEnglish (US)
Pages (from-to)2155-2161
Number of pages7
JournalPain Medicine (United States)
Volume17
Issue number12
DOIs
StatePublished - Dec 1 2016

Fingerprint

Pain
Spine
Physical and Rehabilitation Medicine
Guidelines
Hospital Emergency Service
Trigger Points
Musculoskeletal System
Injections
Electronic Health Records
Evidence-Based Practice
Pain Management
Neurologic Manifestations
Chest Pain
Radiology
Hematoma
Infarction
Spinal Cord
Hypersensitivity
Steroids
Databases

Keywords

  • Adverse event rate
  • Complicate rate
  • Spinal epidural injections
  • Spine

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Immediate adverse events in interventional pain procedures : A multi-institutional study. / Carr, Carrie; Plastaras, Christopher T.; Pingree, Matthew J.; Smuck, Matthew; Maus, Timothy; Geske, Jennifer R.; El-Yahchouchi, Christine A.; McCormick, Zachary L.; Kennedy, David J.

In: Pain Medicine (United States), Vol. 17, No. 12, 01.12.2016, p. 2155-2161.

Research output: Contribution to journalArticle

Carr, C, Plastaras, CT, Pingree, MJ, Smuck, M, Maus, T, Geske, JR, El-Yahchouchi, CA, McCormick, ZL & Kennedy, DJ 2016, 'Immediate adverse events in interventional pain procedures: A multi-institutional study', Pain Medicine (United States), vol. 17, no. 12, pp. 2155-2161. https://doi.org/10.1093/pm/pnw051
Carr, Carrie ; Plastaras, Christopher T. ; Pingree, Matthew J. ; Smuck, Matthew ; Maus, Timothy ; Geske, Jennifer R. ; El-Yahchouchi, Christine A. ; McCormick, Zachary L. ; Kennedy, David J. / Immediate adverse events in interventional pain procedures : A multi-institutional study. In: Pain Medicine (United States). 2016 ; Vol. 17, No. 12. pp. 2155-2161.
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