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.

Keywords: Facet Joint; Fluoroscopy; Interventional; Medial Branch; Physician Performance; Sacroiliac Joint; Zygoapophyseal Joint.

Wiley Periodicals, Inc.