Differences between lumbar and cervical injections affecting the need for sedation
| Author, year | Patient population | Design | Results | Comments |
| Trentman et al 2009257 | 498 pts who received cervical and lumbar transforaminal ESI | Case–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 injections | 3% of cervical pts required sedation vs none in lumbar pts |
| Walega et al 2015256 | 280 pts equally divided between those undergoing cervical and lumbar interlaminar ESI | Prospective observational study | 10% 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 2012126 | 7482 lumbar, thoracic and cervical MBB | Prospective observational study | Incidence 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 2011260 | 1580 adolescent pts with neck and/or back pain | Cross-sectional study | Multinomial 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.