Standard sedation practice questioned

It’s not very often that a standard medical procedure is called into question. However, due to information recently uncovered by researchers at the Johns Hopkins University School of Medicine Blaustein Pain Treatment Center, this rarity just happened. Pain Medicine.

Nerve blocks are injections of anesthetics or steroids into parts of the body to quell the sensation of pain or to pinpoint its origin. They typically target the spinal cord and hip joints. If a nerve block does not decrease pain, physicians often assume that they have misappropriated the pain source. They usually rule out corrective surgery at that point, as it would be unlikely to mitigate patient suffering.

Typically, physicians administer a sedative to a patient before performing a nerve block. Although nerve blocks are administered to patients while awake in order to monitor sensations of pain, the pre-nerve block sedation is thought to calm the patient and reduce general anxiety. This sedation and nerve block duo has become the standard procedure in many treatment centers. It is seen as the logical choice for well-meaning physicians looking to make their patients more comfortable.

In the study results, published in the journal Pain Medicine, lead author Steven P. Cohen, a professor of anesthesiology and School of Medicine, and his team discovered that sedation doesn’t help nerve block procedures. R, it does increase surgery expenses and the risk of surgery-related complications. These disadvantages may be significant, as the Hopkins research shows that some treatment centers sedate every patient before nerve block procedures.

Cohen, with other American medical center researchers, studied over 70 patients to develop the results. These patients, all slated for several nerve block procedures, were divided into two groups. Half of the patients were sedated before the first nerve blocks but not before the second. The other half was treated in the opposite manner: They were only administered sedation before the second nerve block. Immediately after each procedure, the patients were polled regarding their pain and overall satisfaction, and a month later, the patients were asked to respond to a similar survey. While the sedated patients reported less pain immediately following the nerve block procedure, the reported pain was not significantly different for sedated and non-sedated patients a month after the procedure.

This study concludes that, if sedation is administered before surgical procedures, patients are more likely to have surgeries performed that do not cure them of their pain. The researchers think that this is because the administration of sedation before nerve block treatment significantly increases false positives.

Such a false positive effect may be due to the administration of the sedation itself, as it reduces pain and relaxes muscles. If this pain relief lasts beyond the sedation/nerve block combination is administered, patients are likely to report that the nerve block worked. Cohen’s team is questioning the source of the reported pain reduction: Is it the nerve block or the sedation? These researchers think that sedation often interferes with the diagnostic properties of nerve blocks. If this is the case, physicians would incorrectly conclude that the site of the nerve block is the cause of the pain and would proceed with unnecessary surgeries. Not only does this leave the patient with an unresolved pain condition; it pointlessly increases medical costs.

Furthermore, sedation procedures involve significant risks. They slow breathing, lower blood pressure and require close monitoring of vital conditions. Additionally, most patients report feeling drowsy after sedative procedures.

The debate over sedating or not sedating will surely continue as doctors and researchers decide what is ultimately best for the patient.