The Effect of sedation on the accuracy and treatment outcomes for diagnostic injections: A randomized, controlled, crossover study

Steven P. Cohen, Haroon Hameed, Connie Kurihara, Paul F. Pasquina, Amit M. Patel, Mosunmola Babade, Scott R. Griffith, Michael E. Erdek, David E. Jamison, Robert W. Hurley

Research output: Contribution to journalArticlepeer-review

Abstract

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<0.0001), and a higher proportion of patients who obtained>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.

Original languageEnglish (US)
Pages (from-to)588-602
Number of pages15
JournalPain Medicine (United States)
Volume15
Issue number4
DOIs
StatePublished - Apr 2014

Keywords

  • Diagnostic block
  • False positive
  • Sacroiliac joint
  • Sedation
  • Specificity
  • Sympathetic block

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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