Table 16.

Differences between lumbar and cervical injections affecting the need for sedation

Author, year	Patient population	Design	Results	Comments
Trentman et al 2009 [257]	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 2015 [256]	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 2012 [126]	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 2011 [260]	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.