The Effect of Sedation on the Accuracy and Treatment Outcomes for Diagnostic Injections: A Randomized, Controlled, Crossover Study
| Autor: | Haroon Hameed, David E. Jamison, Paul F. Pasquina, Michael E. Erdek, Robert W. Hurley, Amit M. Patel, Steven P. Cohen, Connie Kurihara, Mosunmola Babade, Scott R. Griffith |
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| Rok vydání: | 2014 |
| Předmět: |
Sacroiliac joint
medicine.medical_specialty business.industry Sedation Treatment outcome General Medicine Tertiary care Crossover study Surgery Fentanyl Anesthesiology and Pain Medicine medicine.anatomical_structure Anesthesia medicine Midazolam Neurology (clinical) medicine.symptom Lead (electronics) business medicine.drug |
| Zdroj: | Pain Medicine. 15:588-602 |
| ISSN: | 1526-4637 1526-2375 |
| DOI: | 10.1111/pme.12389 |
| Popis: | Background and Objective Diagnostic injections are used to diagnose myriad pain conditions, but are characterized by a high false-positive rate. One potential cause of inaccurate diagnostic blocks is the use of sedation. We sought to determine the effect of sedation on the validity of diagnostic injections. Design Randomized, crossover study in which 73 patients were allocated to receive a diagnostic sacroiliac joint or sympathetic nerve block performed either with or without sedation using midazolam and fentanyl. Those who obtained equivocal relief, good relief lasting less than 3 months, or who were otherwise deemed good candidates for a repeat injection, received a subsequent crossover injection within 3 months (N = 46). Setting and Patients A tertiary care teaching hospital and a military treatment facility. Results In the primary crossover analysis, blocks performed with sedation resulted in a larger mean reduction in pain diary score than those done without sedation (1.2 [2.6]; P = 0.006), less procedure-related pain (difference in means 2.3 [2.5]; P 50% pain relief on their pain diaries (70% vs. 54%; P = 0.039). The increased pain reduction was not accompanied by increased satisfaction (sedation mean 3.9 [1.1] vs. 3.7 [1.3]; P = 0.26). Similar findings were observed for the parallel group (N = 73) and omnibus (all sedation vs. no sedation blocks, N = 110) analyses. No differences in outcomes were noted between the use and non-use of sedation at 1-month. Conclusions The use of sedation during diagnostic injections may increase the rate of false-positive blocks and lead to misdiagnoses and unnecessary procedures, but has no effect on satisfaction or outcomes at 1-month. |
| Databáze: | OpenAIRE |
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