Table 16

Differences between lumbar and cervical injections affecting the need for sedation

Author, yearPatient populationDesignResultsComments
Trentman et al 2009257498 pts who received cervical and lumbar transforaminal ESICase–control study. Control lumbar injections (n=249) done on same day or the closest day to cervical transforaminal ESI (n=249)8% incidence of vasovagal reaction in cervical group vs 1% for lumbar injections3% of cervical pts required sedation vs none in lumbar pts
Walega et al 2015256280 pts equally divided between those undergoing cervical and lumbar interlaminar ESIProspective observational study10% incidence of vasovagal reaction in cervical group vs 3% for lumbar injections. No difference in movement or vocalizations. More cervical pts requested additional LA (6% vs 1%)Excluded pts with anxiety disorder, who had previous epidural injection or who requested sedation
Manchikanti et al 20121267482 lumbar, thoracic and cervical MBBProspective observational studyIncidence of vasovagal reaction 0.03% (n=1) in cervical spine vs 0% in lumbar and thoracic spine (p=NS)Needle size and use of sedation not noted. Incidence much lower than other reports
Rees et al 20112601580 adolescent pts with neck and/or back painCross-sectional studyMultinomial ORs for anxiety and/or depression for neck pain, back pain, or neck and back pain 1.43 (95% CI 1.20 to 1.70), 1.38 (95% CI 1.15 to 1.66), and 1.98 (95% CI 1.64 to 2.30), respectively.Reference group: adolescents without back or neck pain. Source of pain not identified. Did not address causality
  • ESI, epidural steroid injection; LA, local anesthetic; MBB, medial branch block; NS, not significant.