Impact of sedation on patient satisfaction, radiation exposure, and complications in lumbar transforaminal epidural steroid injections: A retrospective cohort study
Halil İbrahim Altun1
, Salim Taner Gözükızıl2, Fatma Ayşen Eren1, Gözde Altun3, Ayça Sultan Şahin4
1Department of Pain Medicine, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Türkiye
2Department of Pain Medicine, Prof. Dr. Cemil Taşcıoğlu City Hospital, İstanbul, Türkiye
3Department of Anesthesiology and Reanimation, İstanbul University-Cerrahpaşa Cardiology Institute, İstanbul, Türkiye
4Department of Anesthesiology and Reanimation, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Türkiye
Keywords: Conscious sedation, epidural injections, intervertebral disc herniation, radiation exposure, low back pain.
Abstract
Background: This study aims to investigate whether moderate sedation (MOAA/S 3-4) affects procedural efficiency, radiation exposure, patient–physician satisfaction, and clinical outcomes during lumbar transforaminal epidural steroid injections (L-TFESI).
Patients and Methods: Between January 2021 and January 2024, a total of 201 patients with unilateral, single-root compression who underwent L-TFESI either with (Group S, n = 99) or without sedation (Group NS, n = 102) were retrospectively analyzed. In the sedation group, midazolam and fentanyl were titrated to a target Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score of 3-4. The primary outcomes were cumulative radiation dose (mGy), fluoroscopy time, and procedural complications. Additional outcomes included Numeric Rating Scale-11 (NRS-11) scores (baseline, Day 4, Week 4) and Likert satisfaction scales.
Results: Of a total of 201 patients, 143 were male and 58 were female with a mean age of 47.22 ± 10.03 (range, 22 to 65) years. Both groups were comparable in terms of baseline demographics and pain scores. The sedation group had significantly lower cumulative radiation exposure (3.92 ± 0.30 mGy vs. 4.31 ± 0.40 mGy) and shorter fluoroscopy times (28.13 ± 2.79 sec vs. 33.13 ± 3.95 sec). Minor procedural complications (commonly vasovagal reactions and hypertension) were more frequent in the non-sedated group (21.6% vs. 2.0%). Group S reported lower pain scores on Day 4 (1.11 ± 1.29 vs. 1.88 ± 1.25), although outcomes were similar at Week 4. Patient and physician satisfaction were higher in the sedation group.
Conclusion: Moderate sedation (MOAA/S 3-4) during L-TFESI is associated with lower radiation exposure, shorter procedure times and fewer minor complications, while improving both patient satisfaction and procedural conditions. These findings suggest that sedation is a potentially useful adjunct in selected patients that may contribute to improved procedural quality in interventional pain management.
Cite this article as: Altun Hİ, Gözükızıl ST, Eren FA, Altun G, Şahin AS. Impact of sedation on patient satisfaction, radiation exposure, and complications in lumbar transforaminal epidural steroid injections: A retrospective cohort study. Agri 2026;38(3):158-165. doi: 10.5606/agri.2026.52.