• Felix E Diehn, Jennifer R Geske, Kimberly K Amrami, Timothy J Kaufmann, Jonathan M Morris, Naveen S Murthy, Kent R Thielen, John T Wald, Randy A Shelerud, Rickey E Carter, and Timothy P Maus.
• Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA. diehn.felix@mayo.edu
• Pain Med. 2013 Jul 1;14(7):994-8.

ObjectiveTo assess frequency of sedation in transforaminal epidural steroid injections (TFESI) and to analyze patient dissatisfaction and vasovagal rates.DesignRetrospective audit over a 6-year period, January 1, 2006-December 31, 2011.SettingSingle academic center radiology pain management practice.SubjectsFour thousand four hundred thirty-two patients undergoing 6,878 consecutive TFESI.Outcome MeasuresFrequency 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.ResultsSix 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%).ConclusionsIn 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.Wiley Periodicals, Inc.

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