TY - JOUR
T1 - Immediate adverse events in interventional pain procedures
T2 - A multi-institutional study
AU - Carr, Carrie M.
AU - Plastaras, Christopher T.
AU - Pingree, Matthew J.
AU - Smuck, Matthew
AU - Maus, Timothy P.
AU - Geske, Jennifer R.
AU - El-Yahchouchi, Christine A.
AU - McCormick, Zachary L.
AU - Kennedy, David J.
N1 - Publisher Copyright:
© 2016 American Academy of Pain Medicine.
PY - 2016/12/1
Y1 - 2016/12/1
N2 - 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.
AB - 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.
KW - Adverse event rate
KW - Complicate rate
KW - Spinal epidural injections
KW - Spine
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U2 - 10.1093/pm/pnw051
DO - 10.1093/pm/pnw051
M3 - Article
C2 - 28025351
AN - SCOPUS:85020468551
SN - 1526-2375
VL - 17
SP - 2155
EP - 2161
JO - Pain Medicine (United States)
JF - Pain Medicine (United States)
IS - 12
ER -