(Scientific Session) The Effect of Trainee Presence and Fluoroscopy Duration on Intraprocedural Pain Scores in Fluoroscopic-guided Musculoskeletal Procedures: Sub Analysis of a Retrospective Observational Cohort Study

Background and/or Objectives: Trainee involvement in procedures can often be a cause for concern in patients undergoing fluoroscopic-guided musculoskeletal procedures. There is a lack of literature investigating the effect that trainee presence has on intraprocedural pain. We aimed to evaluate the effect of trainee presence and/or involvement as well as fluoroscopy duration on intraprocedural pain scores during fluoroscopic-guided musculoskeletal procedures.

Design: Single center observational cohort study.

Setting: Outpatient procedure clinics within an academic institution with ACGME-accredited physical medicine and rehabilitation residency and sports medicine fellowship as well as NASS-accredited interventional spine fellowship.

Participants: All patients receiving fluoroscopic-guided transforaminal epidural, interlaminar epidural, sacroiliac joint, caudal epidural, facet joint, medial branch/lateral branch block, and medial branch/lateral branch radiofrequency ablation as well as spinal cord stimulator trials, peripheral nerve stimulator trials, and genicular nerve block/radiofrequency ablation.

Interventions: Fluoroscopic-guided musculoskeletal procedures.

Main Outcome Measures: Patient-reported intraprocedural pain score as determined by numeric rating scale (NRS, 0-10), asked by staff member after physician left the room.

Results: A total of 1,102 procedures were performed on 743 patients; trainees were present for 340 procedures, and performed the procedure in 119. The mean intraprocedural pain score with trainee present, trainee involved, and trainee absent were 4.90, 4.76, and 4.77, respectively. Trainee presence (p = 0.997) and involvement (p = 0.472) did not significantly affect intraprocedural pain scores. Fluoroscopy time was similar between trainees being present and not present (p = 0.761), but fluoroscopy times were higher when a trainee performed the injection (linear regression coeff = 13.9 [7.25, 20.5], p < 0.001).

Conclusions: This study demonstrates that trainee presence and involvement does not affect intraprocedural pain scores, but trainee involvement may increase fluoroscopic time exposure. This provides evidence for patients that trainee involvement does not worsen pain experienced during fluoroscopic musculoskeletal procedures.