Disclosures: Brian Malave, BA: No financial relationships or conflicts of interest

Objective: Vasovagal reactions are a benign but common outcome of spinal injections that can negatively impact patient care, including aborted procedures and fear of future procedures that would otherwise help the patient. Research has been done on the incidence, risk factors, and management of vasovagal reactions on an outpatient basis; less is known about how to prevent these reactions from occurring in the first place. In this paper, we present a literature review of the pathophysiology, incidence, risk factors, prevention, and management of vasovagal reaction during spinal injections – with an emphasis on the relative lack of research and conflicting advice on preventative measures.

Design: Literature review

Setting: N/A

Participants: All peer-reviewed scientific publications on vasovagal syncope resulting from spinal injections

Interventions: N/A

Main Outcome Measures: N/A

Results: We found that moderate sedation and anxiolytics have been used prophylactically to prevent vasovagal reactions from interventional spinal procedures, but their side effect profiles prevent them from being used commonly. Less studied is the prophylactic administration of antimuscarinics and obtaining IV access pre-operatively, despite the demonstrated efficacy of these methods for prevention of vasovagal syncope in other clinical settings and relatively low side-effect profile.

Conclusions: IV fluids and anti-muscarinics lower vasovagal reactions in a variety of clinical settings. More research should be done on their use for spinal injections specifically.

Level of Evidence: Level II

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/vasovagal-syncope-during-spinal-injections-a-review-of-pathophysiology-incidence-risk-factors-prevention-and-management/