title: Vasovagal reactions and other complications of cervical vs. lumbar translaminar epidural steroid injections.
abstract: OBJECTIVE
  To document the per patient rate of vasovagal reactions and other complications of cervical vs. lumbar translaminar epidural steroid injections.
  
  
  BACKGROUND
  Anecdotal observations at our institution suggested that vasovagal reactions are much more common during cervical epidural steroid injections than lumbar injections, and more frequent than previously reported.
  
  
  METHODS
  Records of 249 patients undergoing their first cervical epidural steroid injection were reviewed for vasovagal reactions and other adverse events. For comparison, a first lumbar epidural steroid injection performed by the same staff physician was matched to each cervical procedure and reviewed for complications.
  
  
  RESULTS
  The incidence of vasovagal reaction was 7 points more common (P < 0.001, 95% confidence interval 0.04-0.12) in the cervical group (8%) than in the lumbar group (1%). This correlates to an additional vasovagal reaction for every 14 patients who were treated with cervical injection in comparison with those treated with lumbar injection.
  
  
  CONCLUSIONS
  The risk of vasovagal reaction is significantly higher for cervical translaminar epidural steroid injections than for lumbar injections. The risk of vasovagal reaction remained higher for cervical injection even when adjusting for differences between the two populations. The higher rate of cervical vasovagal reactions may result from a combination of anxiety, the prone position with neck flexed, head drapes, and stimulus from a neck procedure.
  
  
  CONCLUSIONS
  Increased vigilance for patients undergoing translaminar cervical epidural steroid injections may be warranted. Clinicians may choose to consider these results when counseling patients regarding risk and the need for conscious sedation during the procedure.
authors.affiliation: Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, Arizona 85054, USA. trentman.terrence@mayo.edu
authors.forename: Terrence L
authors.initials: TL
authors.lastname: Trentman
authors.forename: David M
authors.initials: DM
authors.lastname: Rosenfeld
authors.forename: David P
authors.initials: DP
authors.lastname: Seamans
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Hentz
authors.forename: James P
authors.initials: JP
authors.lastname: Stanek
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D015994:Incidence; D007268:Injections, Epidural / Q000009:adverse effects* / Q000379:methods*; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D019462:Syncope, Vasovagal / Q000453:epidemiology / Q000209:etiology*