Comparison of the contralateral oblique view with the lateral view for mid-thoracic epidural access under fluoroscopic guidance: a randomized controlled trial

et al. 2022

Reg Anesth Pain Med

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IntroductionReal-time ultrasound-guided thoracic epidural catheter placement (US-TECP) has been recently introduced. Patient’s position is associated with the success of spine interventions; however, the effects of position on the outcome of the procedure remain unknown. We aimed to assess the clinical usefulness of patient positioning during real-time US-TECP.MethodsPatients were randomly assigned to the prone position group (group P) and sitting position group (group S). The primary outcome was needling time during the procedure. The secondary outcomes were time to mark space, total number of needle passes, number of skin punctures, first-pass success, final success, crossover success, and visibility of ultrasound (US) views. Global Rating Scale (GRS) score, Patient Comfort Scale score, procedural pain intensity, patient satisfaction, and procedure-related complications were also determined.ResultsSixty-four patients were included in this study. The needling time was significantly shorter in group P than in group S (36.5 (26.5–51.0) vs 59.5 (34.5–152.0) s, p<0.01). The numbers of needle passes and skin punctures were significantly lesser in group P than in group S. First-pass success was higher in group P than in group S. Group P had higher GRS compared with group S. The time to mark space, final success, US visibility score, Patient Comfort Scale score, procedural pain intensity, and patient satisfaction did not differ between the groups. One patient in group S developed a vasovagal reaction.DiscussionThis study shows that prone position may be preferred for real-time US-TECP, considering its better clinical usefulness.Trial registration numberKCT0005757.

Section: Discussionmentioning

confidence: 99%

Comparison of sitting and prone positions for real-time ultrasound-guided thoracic epidural catheter placement: a randomized controlled trial

Shin

Lee

et al. 2022

Reg Anesth Pain Med

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“…The following procedural variables were measured as secondary outcomes: (1) first-pass success: achieving successful epidural access without any backward needle movement and confirmation of contrast dispersion in the epidural space, (2) final success: successful epidural access and confirmation of contrast dispersion in the epidural space, (3) needling time: procedural time from skin puncture to administration of the contrast medium after reaching the epidural space, (4) total number of needle passes: first needle pass plus additional needle passes (ie, readvancement of the needle after any needle withdrawal to change the direction), (5) false-positive LOR: when the needle was not actually placed in the epidural space though LOR was obtained and (6) false-negative LOR: when the needle was placed in the epidural space though LOR was not obtained. When false LOR was suspected, the epidural needle location should be confirmed through fluoroscopy based on the epidural spread of the contrast medium before injecting the medication 13 17…”

Section: Methodsmentioning

confidence: 99%

Contralateral oblique view can prevent dural puncture in fluoroscopy-guided cervical epidural access: a prospective observational study

Kim

et al. 2023

Reg Anesth Pain Med

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IntroductionAlthough the contralateral oblique (CLO) view at 50°±5° is clinically useful for cervical epidural access, no previous studies have confirmed its safety. This prospective observational study was conducted to assess the safety profile, including the risk of dural puncture, in fluoroscopically guided cervical epidural access using the CLO view.MethodsIn cervical epidural access using the CLO view, the incidence of dural puncture was investigated as the primary outcome. Other intraprocedural complications, including intravascular entry, subdural entry, spinal cord injury and vasovagal injury, and postprocedural complications were investigated as secondary outcomes. Procedural variables including first-pass success, final success, needling time, total number of needle passes and false loss of resistance (LOR) were evaluated.ResultsOf the 393 patients who underwent cervical interlaminar epidural access were included for analysis, no instances of dural puncture or spinal cord injury were observed. The incidence of intravascular entry, vasovagal reaction and subdural entry were 3.1%, 0.5% and 0.3%, respectively. All procedures were successfully performed, with 85.0% of first-pass success rate. The mean needling time was 133.8 (74.9) s. The false-positive and false-negative LOR rates were 8.2% and 2.0%, respectively. All needle tips were visualized clearly during the procedure.ConclusionsThe fluoroscopy-guided CLO view at 50°±5° avoided dural puncture or spinal cord injury and decreased the incidence of false LOR during cervical epidural access with a paramedian approach.Trial registration numberNCT04774458.

“…A 20-gauge Tuohy needle was gently advanced under guidance by fuoroscopy. After placing the needle tip between the laminae, being ipsilateral to the symptomatic side of the patient on AP view, the needle was gently advanced using the lateral or contralateral oblique view while confrming the depth by visualizing the spinolaminar line or ventral interlaminar line, respectively [12][13][14]. Upon feeling the ligamentous resistance, the stylet was removed.…”

Section: Intervention: Epidural Steroid Injection With Hs or Nsmentioning

confidence: 99%

Comparison of Adjuvant Hypertonic Saline and Normal Saline for Epidural Block in Patients with Postherpetic Neuralgia: A Double-Blind, Randomized Trial

Pain Research and Management

Kim

Cho

et al. 2022

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Background. In patients with postherpetic neuralgia (PHN), the effectiveness of epidural block and the benefits of adjuvant hypertonic saline (HS) have not been fully determined. Therefore, we investigated these issues in this study. Methods. At a tertiary medical center’s single pain clinic in Seoul, Republic of Korea, patients complaining of PHN even after 4 months of herpes zoster onset were enrolled and randomly assigned to either the HS or normal saline (NS) group. After epidural block with adjuvant HS or NS administration according to each protocol, outcomes were assessed at baseline and one and three months after the intervention. The primary outcome was pain intensity on the numerical rating scale (NRS). The secondary outcomes were the insomnia severity index (ISI), the medication quantification scale (MQS), and the global perceived effect of satisfaction (GPES). Results. Thirty-six patients (NS: 17, HS: 19) were included in the intention-to-treat analysis. The estimated pain intensity decreased in both groups at one and three months after the procedure ( P < 0.001), without a significant group difference. The estimated ISI and MQS were not significantly different at 1 month compared with baseline but significantly decreased at 3 months in each group ( P < 0.001 and P < 0.001, respectively), without group differences. In addition, there was no difference between the groups on the GPES scale at one and three months after the procedure. Conclusions. Epidural steroid injection may have the advantages of short-term pain relief, improved sleep quality, and decreased medication usage in patients with PHN. In addition, adjuvant HS administration with epidural steroid injection did not show beneficial effects in patients with PHN. Further studies are needed to clarify the potential effectiveness of HS in treating neuropathic pain such as PHN. This trial is registered with KCT0002845.