Adverse Events Associated With Fluoroscopically Guided Sacroiliac Joint Injections

• Published in: PM & R 2012-07, Vol.4 (7), p.473-478
• Main Authors: Plastaras, Christopher T., MD, Joshi, Anand B., MD, MHA, Garvan, Cynthia, PhD, Chimes, Gary P., MD, PhD, Smeal, Wesley, MD, Rittenberg, Joshua, MD, Lento, Paul, MD, Stanos, Steven, DO, Fitzgerald, Colleen, MD
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Cohort Studies; Equipment Failure; Female; Fluoroscopy; Flushing - etiology; Humans; Injections, Intra-Articular - adverse effects; Injections, Intra-Articular - methods; Male; Middle Aged; Needles - adverse effects; Pain - etiology; Pain Measurement; Physical Medicine and Rehabilitation; Retrospective Studies; Sacroiliac Joint; Sweating; Syncope, Vasovagal - etiology; Time Factors
• ISSN: 1934-1482; 1934-1563
• DOI: 10.1016/j.pmrj.2012.02.001

Objective To describe the type, incidence, and factors that contribute to adverse events associated with fluoroscopically guided intra-articular sacroiliac joint injections (IASIJ). Design A retrospective cohort study. Setting Tertiary, academic, outpatient physical medicine and rehabilitation interventional spine clinic. Participants English-speaking adults aged 18-90 years who underwent fluoroscopically guided IASIJ injections between March 8, 2004, and April 19, 2007. Interventions After IASIJ injections, 3 senior researchers recorded the presence and types of adverse events. The relationship of adverse events with age, gender, fluoroscopy time, vital signs, and trainee presence was analyzed with the Fisher exact or the Wilcoxon rank sum 2-sided tests. Main Outcome Measures The frequency of immediate (during or immediately after the procedure) or delayed (within 24-72 hours after the procedure) adverse events. Results A total of 162 patients (133 women) underwent 191 procedures. The range of subject age was from 20 to 90 years (15.8 years, standard deviation [SD]). The range (SD) of the preprocedure 11-point Likert Pain Scale was from 1.0 to 10.0 (2.0) and for the postprocedure 11-point Likert Pain Scale was from 0.0 to 9.0 (2.5). Trainees were involved in 57% of the procedures. Reported immediate adverse events were vasovagal reaction (2.1% [n = 4]) and steroid-clogged needle (0.5% [n = 1]). Follow-up data were available for 132 of 191 procedures (69%). There were 32 adverse events reported at a mean follow-up interval of 2 days, of which, the most frequent adverse events were injection-site soreness (12.9% [n = 17]), pain exacerbation (5.3% [n = 7]), and facial flushing and/or sweating (2.3% [n = 3]). Delayed adverse events decreased with older age ( P = .0029). The patients who underwent bilateral procedures experienced more delayed adverse events than the patients who underwent unilateral procedures ( P = .024). Conclusions Fluoroscopically guided IASIJ injection is associated with minimal adverse effects. The most common immediate adverse event was vasovagal reaction, and the most common delayed adverse event was injection-site soreness. Younger age is significantly related to reported delayed adverse events.