Background

Recently the number of outpatient spinal procedures for treatment of spinal pain has significantly increased. In some cases, conscious sedation for pain control and anxiolysis may be necessary to decrease associated discomfort. Safety concerns have been expressed when conscious sedation is performed by non-anesthesiologists. No previous study has evaluated the rate of adverse events (AE) associated with conscious sedation (CS) when used during interventional spine procedures performed by non-anesthesiologists.

Methods

This retrospective cohort study analyzed the AE rates of patients undergoing spinal injection procedures for pain control and diagnostic purposes. AE of procedures with CS were compared to procedures performed with local anesthesia only (LA). AE were documented by nursing staff during and immediately after the procedure. All patients received a follow-up phone call after the procedure. All spinal procedures performed in 2005 in the ambulatory surgery center of a large academic spine center were reviewed (n=3342). 2510 charts were available (75.1%). All procedures were performed by 6 experienced spinal interventionalist's.

Results

Of 2510 patients, 49.6% received CS and 50.4% received LA. 61 patients (2.43% of total) had AE with LA, compared to 70 patients (2.79% of total) with CS. There was no statistical difference in AE between the groups. No serious or clinically significant complication was found in either group. The most common temporary side effect was parasthesia (0.51% LA, 0.40% CS).

Conclusions

The rate of adverse events in ambulatory spinal procedures between patients receiving local anesthetic alone versus conscious sedation showed no statistically significant difference. The overall number of adverse events was low. Most adverse events consisted of mild temporary side effects. Light to moderate conscious sedation appears safe when administered by non-anesthesiologists in a closely monitored environment, and when adhering to published guidelines.