Sedation Not Always Necessary Before Diagnostic Procedure

By Jane Farrell

When it comes to treating chronic pain, sedation may not always be the best choice before the actual procedure, according to new research.

 “Sedation doesn’t help, but it does add expense and risk,” says study leader Steven P. Cohen, M.D., a professor of anesthesiology and critical care medicine at the Johns Hopkins School of Medicine. “In some places, every patient is being sedated. Our research shows it should be used very sparingly.”

A nerve block involves the injection of anesthetics or steroids into a number of areas ranging from the spinal column to the hip joint. It’s often performed just before diagnostic procedures. Increasingly, physicians are using light or even deep sedation to ease anxiety and pain while the injection is given.

But the study, published in Pain Medicine, show that sedation before a nerve block significantly increases false-positive results, which means patients are more likely to be sent in for surgeries and other procedures that won’t cure the underlying pain.

The researchers looked at 73 patients with back or limb pain. The patients were scheduled to receive multiple nerve blocks. About half of them got sedation prior to the nerve blocks, while the rest did not. Each group was given six-hour “pain diaries,” and were asked to rate their satisfaction with the treatment. They also reported a month later on the effectiveness of the treatment.

The sedated patients reported less pain immediately after the nerve block. But among all patients, the results were the same on every other measure, from 30-day pain evaluations to overall satisfaction.

Cohen says that while many physicians may use sedation in a sincere effort to make the procedure less traumatic for patients, there is another motive as well

 “Unfortunately, medicine in many places has become a business. The fact is, you get paid more money to do the procedure with sedation,” he says. “The costs of anesthesia can be more than the fee for the procedure itself.”

Several other centers, including the Cleveland Clinic and the Mayo Clinic in Scottsdale, Arizona, also took part in the study.