Managing Vasovagal Reactions in the Outpatient Pain Clinic Setting: A Review for Pain Medicine Physicians Not Trained in Anesthesiology

Vidri, Ron; Emerick, Trent; Alter, Benedict J.; Brancolini, Scott

doi:10.1093/pm/pnab345

Cited by 6 publications

(8 citation statements)

References 11 publications

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“…Vasovagal reaction is the most common immediate adverse event of interventional pain management procedures, with reported rates ranging from 0 to 4% in the literature [ 2 , 6 , 8 , 9 , 10 , 11 , 12 , 13 ]. Kennedy et al, 2013 [ 8 ] reported an overall vasovagal reaction rate of 2.6% for over 8000 fluoroscopically guided interventional procedures performed over 5 years, but a higher vasovagal rate of 3.5% for epidural steroid injections specifically.…”

Section: Incidencementioning

confidence: 99%

“…The most important risk factor is a history of prior vasovagal reaction. Patients who have had vasovagal reactions in the past are more likely to experience future vasovagal reactions [ 13 , 14 ]. Other risk factors of vasovagal reactions are male sex, age < 65 years, and preprocedure pain score.…”

Section: Risk Factorsmentioning

confidence: 99%

“…Said another way, patients with lower pain at baseline might have a lower threshold for discomfort during interventional pain management procedures and therefore a lower threshold for developing a vasovagal reaction during the procedure. Other risk factors of vasovagal reaction proposed in the literature are baseline hypotension, bradycardia, dehydration, or anxiety [ 13 , 15 ].…”

Section: Risk Factorsmentioning

confidence: 99%

“…For these reasons, some have advised obtaining IV access prior to interventional pain management procedures for patients with a high risk of vasovagal syncope [ 13 , 46 , 48 ]. However, no studies to our knowledge have evaluated whether IV fluid administration during interventional pain management procedures can prevent vasovagal reactions.…”

Section: Preventionmentioning

confidence: 99%

“…If these conservative measures do not work, IV fluids should be started (if they were not started preoperatively) and vasoactive medications considered, such as ephedrine in 5–10 mg increments, glycopyrrolate in 0.2 mg increments, or atropine in 0.4–1.0 mg increments. If the patient continues to have SBP < 90 mmHg, MAP < 65 mmHg, or HR < 50 bpm, then he or she should be transported to an emergency department [ 13 ].…”

Section: Managementmentioning

confidence: 99%

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Vasovagal Reactions during Interventional Pain Management Procedures—A Review of Pathophysiology, Incidence, Risk Factors, Prevention, and Management

Malave

Vrooman

2022

Medical Sciences

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Vasovagal reactions are a benign but common outcome of interventional pain management procedures that can negatively impact patient care, including aborted procedures and fear of future procedures that would otherwise help the patient. Research has been done on the incidence, risk factors, and management of vasovagal reactions resulting from such procedures, but less is known about how to prevent these reactions from occurring. In this paper, we present a literature review of the pathophysiology, incidence, risk factors, prevention, and management of vasovagal reactions during interventional pain management procedures, with an emphasis on the relative lack of research and conflicting advice on preventive measures. We found that moderate sedation and anxiolytics have been used prophylactically to prevent vasovagal reactions, but their side-effect profiles prevent them from being used commonly. Less studied is the prophylactic administration of antimuscarinics and IV fluids, despite the potential benefit of these measures and relatively low side-effect profile. We explore these topics here and offer advice for future research to fill the gaps in our knowledge.

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