title: An audit of transforaminal epidural steroid injections without sedation: low patient dissatisfaction and low vasovagal rates.
abstract: OBJECTIVE
  To assess frequency of sedation in transforaminal epidural steroid injections (TFESI) and to analyze patient dissatisfaction and vasovagal rates.
  
  
  METHODS
  Retrospective audit over a 6-year period, January 1, 2006-December 31, 2011.
  
  
  METHODS
  Single academic center radiology pain management practice.
  
  
  METHODS
  Four thousand four hundred thirty-two patients undergoing 6,878 consecutive TFESI.
  
  
  METHODS
  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.
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA. diehn.felix@mayo.edu
authors.forename: Felix E
authors.initials: FE
authors.lastname: Diehn
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Geske
authors.forename: Kimberly K
authors.initials: KK
authors.lastname: Amrami
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Kaufmann
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Morris
authors.forename: Naveen S
authors.initials: NS
authors.lastname: Murthy
authors.forename: Kent R
authors.initials: KR
authors.lastname: Thielen
authors.forename: John T
authors.initials: JT
authors.lastname: Wald
authors.forename: Randy A
authors.initials: RA
authors.lastname: Shelerud
authors.forename: Rickey E
authors.initials: RE
authors.lastname: Carter
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Maus
mesh_terms: D000368:Aged; D016292:Procedural Sedation / Q000379:methods*; D004824:Epidural Space / Q000502:physiology*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007268:Injections, Epidural; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage* / Q000009:adverse effects; D013564:Sympathetic Nervous System / Q000187:drug effects; D019462:Syncope, Vasovagal / Q000139:chemically induced / Q000453:epidemiology; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000187:drug effects*
chemical_list: D013256:Steroids
keywords: Epidural Steroid; Patient Satisfaction; Sedation; TFESI; Transforaminal