1. 2019;22;E435-E440Variations of Technique in Transforaminal Epidural Steroid Injections and Periprocedural Practices by Interventional Pain Medicine Physicians in the United States
   Cross-Sectional Study
   Christopher G. Gharibo, MD, Kristoffer Padjen, MD, Michael Fakhry, MD, Francisco Narvaez, MD, and Lisa V. Doan, MD.

BACKGROUND: Interlaminar and transforaminal epidural steroid injections (ILESI and TFESI) are commonly performed procedures. However, the United States Food and Drug Administration has required the addition of drug warning labels for injectable corticosteroids. Updated evidence and scrutiny from regulatory agencies may affect practice patterns.

OBJECTIVE: To characterize TFESI practices as well as to provide an update on periprocedural practices for any type of epidural steroid injection (ESI), we surveyed pain medicine physicians in the United States.

STUDY DESIGN and SETTING: This was a cross-sectional survey of pain medicine physicians in the United States.

METHODS: A web-based survey was distributed to pain medicine physicians in the United States selected from the Accreditation Council for Graduate Medical Education accredited pain medicine fellowship program list as well as the American Society of Interventional Pain Physicians membership database. Physicians were queried about TFESI practices, including needle size, use of image guidance, methods to detect vascular uptake, and preference for injectate.

RESULTS: A total of 249 responses were analyzed. Only a minority of respondents reported performing cervical TFESI. There were variations in needle size, methods to detect vascular uptake, and choice of injectate. There were also variations in monitoring practices.

LIMITATIONS: The response rate is a limitation. Thus the results may not be representative of all US pain medicine physicians.

CONCLUSIONS: Though all respondents used image guidance for TFESI, variations in other TFESI practices exist. There are also differences in periprocedural practices. Since the closure of this survey, a multisociety pain workgroup published recommendations regarding ESI practices. Our survey findings support the need for more evidence-based guidelines regarding ESI.

KEY WORDS: Epidrual steroid injections, transforaminal epidural steroid injection, steroids, local anesthetic, survey, interventional pain