- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04453449
The Effect of Midazolam Sedation on Diagnostic Medial Branch Blocks (MBB)
March 3, 2022 updated by: Katherine Nowak, Henry Ford Health System
A Prospective Study Investigating the Effect of Midazolam Sedation on Diagnostic Lumbar Medial Branch Blocks
This prospective observational study aims to investigate the effect of midazolam sedation on the diagnostic validity of diagnostic lumbar medial branch block in patients diagnosed with lumbar spondylosis without myelopathy.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
This prospective observational study aims to investigate the effects of midazolam sedation on the diagnostic validity of lumbar medial branch blocks in patients diagnosed with lumbar spondylosis without myelopathy.
Patients typically receive two subsequent diagnostic blocks prior RFTC, to ensure that the correct location has been targeted.
When patients achieve at least 80% pain relief after both diagnostic blocks, this is considered a positive result and they can proceed to receive RFTC.
If patients have positive diagnostic blocks but their RFTC is not successful, this is considered a false positive diagnostic result.
This study will determine 1) if a higher number of sedated patients proceed to radiofrequency thermocoagulation (RFTC) than non-sedated patients, and 2) if there are a higher number of false positive results in sedated patients.
The hypothesis is that the use of midazolam sedation will increase the number of patients who perceive to have pain relief from their diagnostic block results, resulting in more patients proceeding to RFTC, and that there will be a higher number of false positive results in sedated patients.
The primary outcome measure is the number of sedated versus non-sedated patients that have positive block results.
A positive result will be calculated by having at least one NRS score that is at least 80% lower than their baseline NRS score in the 8 hours following lumbar MBB.
The secondary outcome will be the number of false positive blocks in sedated versus non-sedated patients.
After patients achieve 80% relief after each of the two diagnostic lumbar medial branch blocks and proceeds with lumbar RFTC, we will then collect NRS scores 24 hours after both diagnostic Lumbar MBB, and 4 weeks and at 8 weeks after the lumbar RFTC.
If a patient has not received at least 50% reduction from their baseline NRS score by 8 weeks, this will be considered a false positive.
A 7-point Patient Global Impression of Change (PGIC) score 8 hours after each Lumbar MBB will also be collected, and at 4 weeks and 8 weeks after the lumbar RFTC, and any adverse effects patients experience.
In addition, Oswestry Disability Index (ODI) will be collected at 4 and 8 weeks after lumbar RFTC.
The results of this study will help guide the use of sedation when performing diagnostic blocks on patients with lumbar spondylosis, in order to reduce the number of false positive blocks.
Study Type
Observational
Enrollment (Actual)
95
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Michigan
-
Detroit, Michigan, United States, 48201
- Henry Ford Health System
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Sampling Method
Non-Probability Sample
Study Population
Adult patients diagnosed with Lumbar Spondylosis without Myelopathy at either of five study locations (HFMC - Ford Rd, HFMC Main, HFMC West Bloomfield, HFMC Pierson, HFMC - Jackson) from June 1st, 2020 - June 1st, 2021.
Description
Inclusion Criteria:
- Adult patients at least 18 years of age
- History of axial low back pain for at least 3 months
- Indication for bilateral lumbar medial branch block (L3, L4, L5 medial branch nerves)
- Diagnosis of Lumbar Spondylosis without Myelopathy >4/10 pain on a 0-10 numerical rating scale (NRS)
Exclusion Criteria:
- Low back pain with radiculopathy symptoms (this is a diagnosis of sciatica and treatment is not with lumbar medial branch block)
- Uncontrolled major depression or other mental health issues causing instability
- Pregnant or lactating women
- <18 years old
- History of adverse reaction to either midazolam, lidocaine, or bupivacaine
- Focal neurological deficits, cognitive impairments, or memory issues
- Non-English speaking
- Hearing impaired that are unable to understand verbal instructions
- Active Infection
- On Anticoagulation or Antiplatelet Therapy
- History of Clotting Disorder
- Previous Lumbar Medial Branch Block and/or Lumbar Radiofrequency Ablation
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Observational Models: Case-Control
- Time Perspectives: Prospective
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
No sedation
Patients who will undergo the diagnostic lumbar medial branch blocks without sedation (control group).
|
|
Sedation
Patients who will undergo the diagnostic lumbar medial branch blocks with midazolam sedation (treatment group).
|
Midazolam given as a sedative during diagnostic lumbar medial branch block
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of positive blocks
Time Frame: 8 hours post diagnostic block
|
The number of positive diagnostic lumbar medial branch blocks (defined by at least 80% pain relief) in patients who receive midazolam sedation during their diagnostic blocks will be compared to patients who do not receive sedation.
|
8 hours post diagnostic block
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of false positive blocks
Time Frame: 2.5-3 months
|
The number of false positive diagnostic lumbar medial branch blocks (defined by at least 80% pain relief in the two diagnostic blocks, and then less than 80% pain relief following the subsequent radiofrequency thermocoagulation treatment) in patients who receive midazolam sedation during their diagnostic blocks will be compared to patients who do not receive sedation.
|
2.5-3 months
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient Global Impression of Change-7 (PGIC-7) scores
Time Frame: 24 hours post diagnostic block; 4 and 8 weeks after radiofrequency thermocoagulation
|
The PGIC-7 scores of patients who received sedation will be compared to those who did not receive sedation during their diagnostic lumbar medial branch block.
|
24 hours post diagnostic block; 4 and 8 weeks after radiofrequency thermocoagulation
|
Oswestry Disability Index (ODI) scores
Time Frame: 4 and 8 weeks after radiofrequency thermocoagulation
|
The ODI scores of patients who received sedation will be compared to those who did not receive sedation during their diagnostic lumbar medial branch block.
|
4 and 8 weeks after radiofrequency thermocoagulation
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
June 25, 2020
Primary Completion (Actual)
September 1, 2021
Study Completion (Actual)
October 15, 2021
Study Registration Dates
First Submitted
June 27, 2020
First Submitted That Met QC Criteria
June 27, 2020
First Posted (Actual)
July 1, 2020
Study Record Updates
Last Update Posted (Actual)
March 7, 2022
Last Update Submitted That Met QC Criteria
March 3, 2022
Last Verified
March 1, 2022
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Musculoskeletal Diseases
- Spinal Diseases
- Bone Diseases
- Spondylosis
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Anesthetics, Intravenous
- Anesthetics, General
- Anesthetics
- Tranquilizing Agents
- Psychotropic Drugs
- Hypnotics and Sedatives
- Adjuvants, Anesthesia
- Anti-Anxiety Agents
- GABA Modulators
- GABA Agents
- Midazolam
Other Study ID Numbers
- 14010
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
Yes
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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