title: Immediate Adverse Events in Interventional Pain Procedures: A Multi-Institutional Study.
abstract: 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.
  
  
  
  To evaluate adverse event rate for interventional spine procedures performed at three academic interventional spine practices.
  
  
  
  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.
  
  
  
  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.
  
  
  
  This study demonstrates that interventional pain procedures are safely performed with extremely low immediate adverse event rates when evidence-based guidelines are observed.
authors.affiliation: *Department of Radiology, Mayo Clinic, Rochester, Minnesota carr.carrie@mayo.edu.
authors.forename: Carrie M
authors.initials: CM
authors.lastname: Carr
authors.affiliation: Department of Physical Medicine and Rehabilitation (Northwestern University/The Rehabilitation Institute of Chicago), Penn Spine Center, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Plastaras
authors.affiliation: Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Pingree
authors.affiliation: Department of Orthopedic Surgery, Stanford University, Stanford, California.
authors.forename: Matthew
authors.initials: M
authors.lastname: Smuck
authors.affiliation: *Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Maus
authors.affiliation: Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Geske
authors.affiliation: Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Christine A
authors.initials: CA
authors.lastname: El-Yahchouchi
authors.affiliation: Rehabilitation Institute of Chicago, Northwestern University School of Medicine, Chicago, Illinois, USA.
authors.forename: Zachary L
authors.initials: ZL
authors.lastname: McCormick
authors.affiliation: Department of Orthopedic Surgery, Stanford University, Stanford, California.
authors.forename: David J
authors.initials: DJ
authors.lastname: Kennedy
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D019771:Axotomy / Q000009:adverse effects / Q000379:methods; D001416:Back Pain / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects*; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects*; D059408:Pain Management / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Adverse Event Rate; Complicate Rate; Spinal Epidural Injections; Spine