Multicenter, Randomized, Comparative Cost-effectiveness Study Comparing 0, 1, and 2 Diagnostic Medial Branch (Facet Joint Nerve) Block Treatment Paradigms before Lumbar Facet Radiofrequency Denervation

被引:149
作者
Cohen, Steven P. [1 ,2 ]
Williams, Kayode A. [3 ]
Kurihara, Connie [4 ]
Nguyen, Conner [5 ]
Shields, Cynthia [6 ]
Kim, Peter [7 ]
Griffith, Scott R. [6 ,8 ]
Larkin, Thomas M.
Crooks, Matthew [9 ]
Williams, Necia [10 ]
Morlando, Benny [4 ]
Strassels, Scott A. [11 ]
机构
[1] Johns Hopkins Sch Med, Dept Anesthesiol & Crit Care Med, Baltimore, MD USA
[2] Walter Reed Army Med Ctr, Washington, DC 20307 USA
[3] Johns Hopkins Sch Med, Dept Anesthesiol, Baltimore, MD USA
[4] Walter Reed Army Med Ctr, Pain Management Div, Anesthesia Serv, Dept Surg, Washington, DC 20307 USA
[5] Landstuhl Reg Med Ctr, Phys Med & Rehabil Serv, Dept Surg, Landstuhl, Germany
[6] Uniformed Serv Univ Hlth Sci, Dept Anesthesiol, Bethesda, MD 20814 USA
[7] Univ So Calif, Sch Med, Dept Anesthesiol, Los Angeles, CA USA
[8] Walter Reed Army Med Ctr, US Army Surg Gen, Washington, DC 20307 USA
[9] Univ Calif Los Angeles, UCLA Pain Management Ctr, UCLA Med Ctr, Los Angeles, CA USA
[10] Walter Reed Natl Mil Med Ctr, Combined Anesthesia Serv, Bethesda, MD USA
[11] Univ Texas Austin, Div Pharm Practice, Austin, TX 78712 USA
关键词
LOW-BACK-PAIN; DOUBLE-BLIND; ZYGAPOPHYSEAL-JOINT; CLINICAL-TRIAL; NEUROTOMY; INJECTION; DISC; DISCOGRAPHY; MANAGEMENT;
D O I
10.1097/ALN.0b013e3181e33ae5
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Among patients presenting with axial low back pain, facet arthropathy accounts for approximately 10-15% of cases. Facet interventions are the second most frequently performed procedures in pain clinics across the United States. Currently, there are no uniformly accepted criteria regarding how best to select patients for radiofrequency denervation. Methods: A randomized, multicenter study was performed in 151 subjects with suspected lumbar facetogenic pain comparing three treatment paradigms. Group 0 received radiofrequency denervation based solely on clinical findings; group 1 underwent denervation contingent on a positive response to a single diagnostic block; and group 2 proceeded to denervation only if they obtained a positive response to comparative blocks done with lidocaine and bupivacaine. A positive outcome was predesignated as >= 50% pain relief coupled with a positive global perceived effect persisting for 3 months. Results: In group 0, 17 patients (33%) obtained a successful outcome at 3 months versus eight patients (16%) in group 1 and 11 (22%) patients in group 2. Denervation success rates in groups 0, 1, and 2 were 33, 39, and 64%, respectively. Pain scores and functional capacity were significantly lower at 3 months but not at 1 month in group 2 subjects who proceeded to denervation compared with patients in groups 0 and 1. The costs per successful treatment in groups 0, 1, and 2 were $6,286, $17,142, and $15,241, respectively. Conclusions: Using current reimbursement scales, these findings suggest that proceeding to radiofrequency denervation without a diagnostic block is the most cost-effective treatment paradigm.
引用
收藏
页码:395 / 405
页数:11
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