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Effect of Sedation on Diagnostic Injections

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EstadoTerminado
Patrocinadores
Johns Hopkins University
Colaboradores
Walter Reed National Military Medical Center

Palabras clave

Abstracto

Interventional pain procedures have diagnostic, prognostic and therapeutic value. It is well-documented that the reference standard for identifying a pain generator is a low-volume block performed with local anesthetic, with or without steroid. Many factors may increase the false positive (FP) rate of diagnostic and prognostic nerve blocks; however, the use of sedation is the most controversial and remediable. Proponents of sedation argue that it has little effect on the rate of positive diagnostic blocks, and may even reduce the false-negative rate. The purpose of this study is to determine the effect of intravenous sedation on pain relief and the "false-positive rate" after diagnostic nerve blocks.

Descripción

Sixty-eight patients with sacroiliac (SI) joint or sympathetically-maintained pain will be randomized in a crossover fashion to receive diagnostic nerve blocks either with or without intravenous sedation. Among those who obtain some benefit and return for a 2nd block, this 2nd procedure will be done with sedation if the first was done without sedation, and vice versa. Midazolam and fentanyl will be used for intravenous sedation, titrated to anxiolysis and analgesia. Pain scores (0-10 numerical rating scale, or NRS) and an activity log will be recorded over the 8-hours following the blocks via a pain diary. The first follow-up visit will be 4 weeks after the procedure. Patients who obtain some benefit but continue to report significant pain or who might otherwise benefit from a repeat procedure will have this second procedure performed with sedation if no sedation was given for the first procedure, and without sedation if sedation was administered for the first procedure. The post-procedure pain data will be recorded in the same fashion as the initial nerve block. The second follow-up visit will be 4 weeks after the 2nd block.

fechas

Verificado por última vez: 09/30/2016
Primero enviado: 04/24/2011
Inscripción estimada enviada: 11/15/2011
Publicado por primera vez: 11/16/2011
Última actualización enviada: 10/30/2016
Última actualización publicada: 12/14/2016
Fecha de los primeros resultados enviados: 03/18/2014
Fecha de los primeros resultados de CC enviados: 05/18/2014
Fecha de los primeros resultados publicados: 06/15/2014
Fecha de inicio real del estudio: 02/28/2011
Fecha estimada de finalización primaria: 01/31/2013
Fecha estimada de finalización del estudio: 01/31/2013

Condición o enfermedad

Sacroiliac Joint Pain
Sympathetically Maintained Pain

Intervención / tratamiento

Drug: Sedation

Drug: Sedation

Fase

-

Grupos de brazos

BrazoIntervención / tratamiento
Experimental: Sedation
Pt will receive sedation with their procedure
Drug: Sedation
Used for anxiolysis
No Intervention: Control
Patient will not receive sedation during procedure

Criterio de elegibilidad

Edades elegibles para estudiar 18 Years A 18 Years
Sexos elegibles para estudiarAll
Acepta voluntarios saludablessi
Criterios

Inclusion Criteria:

- Chronic pain > 4 weeks but < 10 years in duration

- Suspected SI joint or sympathetically-maintained pain based on history and physical exam

- May benefit from a sacroiliac joint or sympathetic block

- Pain on 0-10 NRS scale > 3/10 in intensity

Exclusion Criteria:

- No previous interventional pain-alleviating injections for the same condition within the past 3 years

- Uncontrolled coagulopathy

- Pregnancy, which will be ruled out by a urine pregnancy test in women of childbearing age

- Allergy to contrast dye or amide local anesthetics

- Unstable medical or psychiatric condition (e.g. unstable angina, congestive heart failure or severe depression) that could preclude an optimal treatment response

- Systemic infection

- Age < 18 or > 75 years

Salir

Medidas de resultado primarias

1. Pain Score [through 6 hours after injection]

pain diary using 0-10 scale, with 0 being no pain and 10 being the worst pain imaginable

Medidas de resultado secundarias

1. Pain Score [1-month]

0-10 numerical rating scale (NRS) pain scale. 0 being no pain and 10 being the worst possible pain.

2. Procedure-related Pain Score [1 day]

0-10 pain scale, with 0 being no pain and 10 being the worst pain imaginable

3. Oswestry Disability Index [1-month]

Measure of functional capacity on a scale ranging from 0% to 100%, with 0% signifying no disability

4. Satisfaction [1 day]

5-point Likert scale. The scale is from 1-5. 1 being very unsatisfied and 5 being very satisfied.

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