Table 16.

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.