Vasovagal Rates in Flouroscopically Guided Interventional Procedures: A Study of Over 8,000 Injections

• Published in: Pain medicine (Malden, Mass.) Mass.), 2013-12, Vol.14 (12), p.1854-1859
• Main Authors: Kennedy, David J., Schneider, Byron, Casey, Ellen, Rittenberg, Joshua, Conrad, Bryan, Smuck, Matthew, Plastaras, Christopher T.
• Format: Article
• Language: English
• Subjects: Aged; Facet Joint; Female; Fluoroscopy; Fluoroscopy - methods; Humans; Injections, Intra-Articular - adverse effects; Injections, Spinal - adverse effects; Interventional; Male; Medial Branch; Medical research; Middle Aged; Nerve Block - adverse effects; Physician Performance; Radiology, Interventional - methods; Retrospective Studies; Risk Factors; Sacroiliac Joint; Syncope, Vasovagal - epidemiology; Syncope, Vasovagal - etiology; Zygoapophyseal Joint
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1111/pme.12241

Objective To determine the rate of vasovagal (vv) complications in fluoroscopically guided interventional procedures. Design Retrospective case series analysis of prospectively collected data from March 8, 2004 to January 30, 2009. Setting A single academic medical center. Subjects Four thousand one hundred eighty‐three subjects undergoing 8,010 consecutive injections. Outcome Measures Pearson's chi‐square test was used to determine the relationship between categorical variables. Results A total of 8,010 injections, including epidural steroid injections, radiofrequency nerve ablations, medial branch blocks, hip injections, knee injections, and glenohumeral injections were performed. Overall vv reaction rate was 2.6%, with 0.8% of procedures resulting in early terminated due to vv reaction. Peripheral joint injections had a vv rate of 0.2%, all occurring in hip injections. Transforaminal epidural steroid injections had a vv rate of 3.5%. Diagnostic blocks of the medial branches had the highest rate of vv (5.1%). Other predictors of vv reactions were identified including preprocedure pain score visual analog scale