An Audit of Transforaminal Epidural Steroid Injections Without Sedation: Low Patient Dissatisfaction and Low Vasovagal Rates


  • Presented at International Spine Intervention Society (ISIS) Annual Meeting in Las Vegas, July 2012.
  • Disclosures/conflicts of interest: Dr. Timothy Maus is on the board of directors for ISIS.

Reprint requests to: Felix E. Diehn, MD, Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA. Tel: 507-255-6598; Fax: 507-266-1657; E-mail:



To assess frequency of sedation in transforaminal epidural steroid injections (TFESI) and to analyze patient dissatisfaction and vasovagal rates.


Retrospective audit over a 6-year period, January 1, 2006–December 31, 2011.


Single academic center radiology pain management practice.


Four thousand four hundred thirty-two patients undergoing 6,878 consecutive TFESI.

Outcome Measures

Frequency of sedation for TFESI was assessed. Vasovagal and patient dissatisfaction rates were assessed, the latter by patients' responses to two follow-up survey questions at 2 weeks postprocedure.


Six thousand eight hundred seventy-eight TFESI were performed, of which only 0.1% (N = 7) were performed with sedation. Only 0.4% (N = 28) of TFESI were complicated by vasovagal reaction. Seventy-two percent (N = 4,980) of nonsedated patients responded to the survey. Overall medical care in the nonsedated was rated as: excellent 51%, very good 30%, good 15%, fair 3%, and poor 1%. Ninety-five percent confidence interval (CI) for the 3.9% of the nonsedated patients who rated their care at best “fair” was (3.3, 4.4%). Likelihood of referring friends/family members in nonsedated patients was: definitely 53%, probably 28%, uncertain 16%, probably not 3%, definitely not 0.2%. Ninety-five percent CI for the 3.2% of the nonsedated patients who would at best “probably not refer” their friends/family was (2.7, 3.7%).


In our radiology pain management practice, sedation was rarely utilized for TFESI. A small minority of nonsedated patients rated their care at best fair and would at best probably not refer friends/family members. TFESI can be performed without sedation with low patient dissatisfaction and low vasovagal rates.