Is sedation indicated before spinal injections?

Abstract

Study design: Survey.

Objective: The purpose of this research was to help determine whether sedation is indicated before lumbar and cervical interventional pain management procedures, and additionally, to determine whether benzodiazepams are effective at controlling anxiety for these procedures.

Summary of background data: The use of sedation before diagnostic and therapeutic epidurals seems to vary widely and no guidelines have been issued that address whether sedation is indicated and for which patients. There is a need to provide periprocedural protocols to provide the safest, most comfortable experience for the patient.

Methods: Three hundred one consecutive spinal injection patients were given a choice to take oral or IV diazepam, or no sedation before a spinal injection. All participating patients filled in a validated anxiety questionnaire before the injection. Patients were asked after the injection whether they were satisfied with their decision regarding sedation and whether their anxiety was controlled effectively.

Results: Fifty-eight percent of our patients chose to be sedated. Those patients who requested sedation were more anxious. The majority of patients were satisfied with their decision regarding sedation, and diazepam effectively controlled anxiety in 90% of patients.

Conclusion: Routine sedation does not seem to be required for patients receiving spinal injections, but more-anxious patients benefit from sedation before an injection. Benzodiazepams are effective in controlling anxiety for the majority of patients.