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

Abstract

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 <5 (P = 0.004), male gender (P < 0.001), and age less than 65 years old (P < 0.001). Conclusions vv reactions have an overall low occurrence rate (2.6%) in interventional procedures ranging from 0% in peripheral knee and shoulder injections to 5.1% in medial branch blocks. Conservative treatment of vv reaction and willingness to terminate procedures resulted in no serious adverse events related to vv reaction in 8,010 procedures.

Evaluation of Complications Associated With Transforaminal Epidural Steroid Injection Administered in Lumbosacral Radiculopathy

“…This observation is in consonance with David J. Kennedy et al (2013). 19 They reported an incidence of 3.6% vasovagal reaction in their study.…”

“…14 Since TFESI has become the preferred method of treatment of back pain with radiculopathy, it has become important to recognize the complications if any associated with this procedure and the effect of these complications. 15,16,17,18,19,20,21,22 Arnold T Berman et al (1984) studied the effects of epidural injection and local anaesthetics and corticosteroids in patients with lumbosciatic pain. They observed some complications such as transient hypotension, difficulty in voiding, severe paraesthesias, cardiac angina, sinus arrhythmias, respiratory difficulty and headache.…”

Efficacy of Transforaminal Epidural Steroid Injection in Lumbosacral Radiculopathy

“…The observation is in consonance with David J. Kennedy, et al (2013). 20 who reported an incidence of 3.6% vasovagal reaction in their study.…”

“…Kennedy, et al (2013). 20 who reported an incidence of 3.6% vasovagal reaction in their study. Another study done by Karaman, et al reported a vasovagal reaction in 8.7% patients.…”

History of syncope predicts loss of consciousness after head trauma: Retrospective study

“…However, among various medical procedures, the rate of syncopal events depends on the type of procedure being about 0.01% for vaccination, and 1% for colonoscopy or transthoracic pleural biopsy, up to 5.1% during diagnostic injection [21][22][23][24]. It may be presumed that head trauma evokes a high level of emotion, especially if associated with skin injury, pain, bleeding etc.…”