Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Sedation before nerve block increases risk, not pain relief

13.02.2014
New research suggests that sedating patients before a nerve block needed to diagnose or treat chronic pain increases costs, risks and unnecessary surgeries, and sedation does nothing to increase patient satisfaction or long-term pain control.

"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 University School of Medicine. "In some places, every patient is being sedated. Our research shows it should be used very sparingly."

Nerve blocks, performed by injecting anesthetics and/or steroids into any number of areas of the body, from the spinal column to the hip joint, are often performed ahead of surgery and in addition to other invasive procedures, such as the ablation of nerves to treat arthritis in the back, to more accurately pin down the source of pain. If the nerve block fails to numb pain, surgery or the nerve ablation may not help. Increasingly, physicians have used light or even deep sedation in a bid to ease anxiety and pain while the injection is given.

However, results of the new study, reported online Feb. 13 in the journal 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. Another worry, Cohen says, is the health risk when someone is sedated.

Cohen and researchers from several other medical centers in the United States recruited 73 patients with back or limb pain who were scheduled to receive multiple nerve blocks. Roughly half of the group received the first injection with sedation and the second without. The remaining patients received their injections in the opposite order. Patients were given six-hour pain diaries, a routine step that helps patients determine whether the injections bring relief, and were asked to rate their satisfaction with the treatment. They were also seen a month later and asked to rate their pain and function after the treatment.

Although the sedated patients reported less pain immediately after the nerve block injection, on every other measure — from 30-day pain assessments to overall patient satisfaction — the results were the same whether or not they were sedated.

"A lot of cost for very little benefit," Cohen says.

The increase in false-positive results — the belief that the pain has been relieved when it has not been — can result from many factors, Cohen says. The medication used for the sedation itself can have pain-relieving properties. The sedative can relax muscles. Patients may need to take extra time away from daily activities after being under anesthesia, and that rest alone could make the patient feel better.

But if patients believe that the nerve block eased their underlying pain, the physician will often conclude he or she has found the source and will move ahead with the appropriate treatment, which may include spinal fusion or radiofrequency ablation of nerves for arthritis, Cohen says. In the end, he says, many patients end up back at square one — still in pain, but having suffered through a potentially unnecessary operation.

Cohen says that while many physicians may use sedation in a sincere effort to make the procedure less traumatic for patients, there is also a perverse financial incentive to use it.

"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. And patients are getting harmed."

The research was funded by the Center for Rehabilitation Sciences Research, part of the Uniformed Services University of the Health Sciences in Bethesda, Md.

Haroon Hameed, M.D., and Michael E. Erdek, M.D., both of Johns Hopkins, contributed to this study, as well as researchers from Walter Reed National Military Medical Center in Bethesda; the Uniformed Services University of the Health Sciences; the Mayo Clinic in Scottsdale, Ariz.; the Cleveland Clinic in Ohio; and the University of Florida in Gainesville.

Johns Hopkins Medicine (JHM), headquartered in Baltimore, Maryland, is a $6.7 billion integrated global health enterprise and one of the leading health care systems in the United States. JHM unites physicians and scientists of the Johns Hopkins University School of Medicine with the organizations, health professionals and facilities of The Johns Hopkins Hospital and Health System. JHM's vision, "Together, we will deliver the promise of medicine," is supported by its mission to improve the health of the community and the world by setting the standard of excellence in medical education, research and clinical care. Diverse and inclusive, JHM educates medical students, scientists, health care professionals and the public; conducts biomedical research; and provides patient-centered medicine to prevent, diagnose and treat human illness. JHM operates six academic and community hospitals, four suburban health care and surgery centers, and more than 30 primary health care outpatient sites. The Johns Hopkins Hospital, opened in 1889, was ranked number one in the nation for 21 years in a row by U.S. News & World Report.

Media Contacts:
Stephanie Desmon; 410-955-8665; sdesmon1@jhmi.edu
Lauren Nelson; 410-955-8725; lnelso35@jhmi.edu

Stephanie Desmon | EurekAlert!
Further information:
http://www.jhmi.edu

More articles from Health and Medicine:

nachricht Custom-tailored strategy against glioblastomas
26.09.2016 | Rheinische Friedrich-Wilhelms-Universität Bonn

nachricht New leukemia treatment offers hope
23.09.2016 | King Abdullah University of Science and Technology

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: New welding process joins dissimilar sheets better

Friction stir welding is a still-young and thus often unfamiliar pressure welding process for joining flat components and semi-finished components made of light metals.
Scientists at the University of Stuttgart have now developed two new process variants that will considerably expand the areas of application for friction stir welding.
Technologie-Lizenz-Büro (TLB) GmbH supports the University of Stuttgart in patenting and marketing its innovations.

Friction stir welding is a still-young and thus often unfamiliar pressure welding process for joining flat components and semi-finished components made of...

Im Focus: First quantum photonic circuit with electrically driven light source

Optical quantum computers can revolutionize computer technology. A team of researchers led by scientists from Münster University and KIT now succeeded in putting a quantum optical experimental set-up onto a chip. In doing so, they have met one of the requirements for making it possible to use photonic circuits for optical quantum computers.

Optical quantum computers are what people are pinning their hopes on for tomorrow’s computer technology – whether for tap-proof data encryption, ultrafast...

Im Focus: OLED microdisplays in data glasses for improved human-machine interaction

The Fraunhofer Institute for Organic Electronics, Electron Beam and Plasma Technology FEP has been developing various applications for OLED microdisplays based on organic semiconductors. By integrating the capabilities of an image sensor directly into the microdisplay, eye movements can be recorded by the smart glasses and utilized for guidance and control functions, as one example. The new design will be debuted at Augmented World Expo Europe (AWE) in Berlin at Booth B25, October 18th – 19th.

“Augmented-reality” and “wearables” have become terms we encounter almost daily. Both can make daily life a little simpler and provide valuable assistance for...

Im Focus: Artificial Intelligence Helps in the Discovery of New Materials

With the help of artificial intelligence, chemists from the University of Basel in Switzerland have computed the characteristics of about two million crystals made up of four chemical elements. The researchers were able to identify 90 previously unknown thermodynamically stable crystals that can be regarded as new materials. They report on their findings in the scientific journal Physical Review Letters.

Elpasolite is a glassy, transparent, shiny and soft mineral with a cubic crystal structure. First discovered in El Paso County (Colorado, USA), it can also be...

Im Focus: Complex hardmetal tools out of the 3D printer

For the first time, Fraunhofer IKTS shows additively manufactured hardmetal tools at WorldPM 2016 in Hamburg. Mechanical, chemical as well as a high heat resistance and extreme hardness are required from tools that are used in mechanical and automotive engineering or in plastics and building materials industry. Researchers at the Fraunhofer Institute for Ceramic Technologies and Systems IKTS in Dresden managed the production of complex hardmetal tools via 3D printing in a quality that are in no way inferior to conventionally produced high-performance tools.

Fraunhofer IKTS counts decades of proven expertise in the development of hardmetals. To date, reliable cutting, drilling, pressing and stamping tools made of...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

European Health Forum Gastein 2016 kicks off today

28.09.2016 | Event News

Laser use for neurosurgery and biofabrication - LaserForum 2016 focuses on medical technology

27.09.2016 | Event News

Experts from industry and academia discuss the future mobile telecommunications standard 5G

23.09.2016 | Event News

 
Latest News

New imaging technique in Alzheimer’s disease - opens up possibilities for new drug development

28.09.2016 | Medical Engineering

Innovate coating extends the life of materials for industrial use

28.09.2016 | Materials Sciences

Blockchain Set to Transform the Financial Services Market

28.09.2016 | Business and Finance

VideoLinks
B2B-VideoLinks
More VideoLinks >>>