Prediction of successful caudal epidural injection using color Doppler ultrasonography in the paramedian sagittal oblique view of the lumbosacral spine

Yoo, Seon Woo; Ki, Min-Jong; Doo, A Ram; Woo, Cheol Jong; Kim, Ye Sull; Son, Ji-Seon

doi:10.3344/kjp.2021.34.3.339

Cited by 6 publications

(5 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other studies have suggested excellent reliability of color Doppler ultrasonography on injection through a needle in the caudal space in the adult14 15 or pediatric16 population. However, this cannot be directly extrapolated to assessment of a catheter in the lumbar epidural space.…”

Section: Discussionmentioning

confidence: 99%

Color flow Doppler in spinal ultrasound: a novel technique for assessment of catheter position in labor epidurals

Bosch

Gleicher

Arzola

et al. 2022

Reg Anesth Pain Med

View full text Add to dashboard Cite

BackgroundUltrasound is commonly used to facilitate epidural catheter placement. However, data are lacking regarding its potential to confirm its position in the epidural space. Our aim was to visualize flow in the epidural space of patients receiving epidural analgesia for labor using color flow Doppler ultrasound.MethodsWe conducted a prospective observational cohort study that included patients who had delivered vaginally under epidural analgesia. We used a 5–2 mHz curvilinear probe in a left and right paramedian longitudinal oblique view to visualize the anterior and posterior complex at the interspace of epidural catheter insertion, one and two interspaces above and below. At each window, the color flow Doppler function was used to visualize flow within the epidural space on injection of normal saline (1 mL). If no flow was visualized at any interspace, one assessment at the level of insertion was repeated with a 1 mL air/saline mixture. We studied a convenience sample size of 40 patients.ResultsWe visualized flow in the epidural space in all 40 patients. Flow was visualized on injection of 1 mL of saline in 37/40 patients (93%). In the remaining 3/40 patients (7%), flow was visualized with an air/saline mixture. Flow on injection of saline was visualized only at the interspace of insertion in 26/37 patients (70%), at the interspace of insertion and one interspace above in 10/37 (27%), or only at one interspace above in 1/37 (3%). Flow was visualized only on the left or on the right paramedian view in 19/37 patients (51%), despite a symmetrical sensory block in all patients.ConclusionColor flow Doppler ultrasound is a feasible and fast way to determine flow in the epidural space in the obstetric population. Its potential clinical uses are confirmation of the epidural catheter position after placement, as well as troubleshooting of unsatisfactory epidural analgesia. Interestingly, our results suggest that epidural catheters predominantly remain at the interspace of insertion.Trial registration numberNCT05126745.

show abstract

Section: Discussionmentioning

confidence: 99%

Color flow Doppler in spinal ultrasound: a novel technique for assessment of catheter position in labor epidurals

Bosch

Gleicher

Arzola

et al. 2022

Reg Anesth Pain Med

View full text Add to dashboard Cite

show abstract

“…Third, there are several different methods to assess CLAI, such as manual anterior drawer test, stress radiography, ultrasound examination or arthroscopy have been proved to be effective at discriminating CLAI. [24][25][26][27][28][29][30][31][32][33] However, we analyzed the PTFLCSA and PTFLT on MRI only.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of the posterior talofibular ligament area for chronic lateral ankle instability

et al. 2023

View full text Add to dashboard Cite

An injured posterior talofibular ligament (PTFL) is one of the reasons for chronic lateral ankle instability (CLAI). Previous researches have demonstrated that the PTFL thickness (PTFLT) is associated with chronic ligament injuries. However, ligament hypertrophy is different from ligament thickness. Thus, we created the PTFL cross-sectional area (PTFLCSA) as a diagnostic image parameter to assess the hypertrophy of the whole PTFL. We assumed that the PTFLCSA is a key morphological diagnostic parameter in CLAI. PTFL data were obtained from 15 subjects with CLAI and from 16 normal individuals. The T1-weighted axial ankle-MR (A-MR) images were acquired at the level of PTFL. We measured the PTFLT and PTFLCSA at the posterior aspect of the ankle using our imaging analysis program. The PTFLT was measured as the thickness between point of anterior and posterior fiber of PTFL. The PTFLCSA was calculated as the whole cross-sectional PTFL area. The average PTFLT was 3.43 ± 0.52 mm in the healthy group and 4.89 ± 0.80 mm in the CLAI group. The mean PTFLCSA was 41.06 ± 12.18 mm 2 in the healthy group and 80.41 ± 19.14 mm 2 in the CLAI group. CLAI patients had significantly greater PTFLT ( P < .001) and PTFLCSA ( P < .001) than the healthy group. A receiver operating characteristic curve analysis demonstrated that the optimal cutoff score of the PTFLT was 4.19 mm, with 93.3% sensitivity, 93.7% specificity, and an area under the curve of 0.97. The most suitable cutoff value of the PTFLCSA was 61.15 mm 2 , with 93.3% sensitivity, 100% specificity, and area under the curve of 0.99. Even though the PTFLT and PTFLCSA were both significantly associated with CLAI, the PTFLCSA was a more exact morphological measurement parameter.

show abstract

“…Additionally, in Japan, lumbar epidural block is divided into two types of procedures: caudal epidural block and interlaminar epidural block. Although it may vary depending on the patients, there is generally an obvious difference in the technical difficulty between these two methods [ 23 , 24 ]. Thus, there is a need to introduce a fee structure reflecting this discrepancy in Korea.…”

Section: Discussionmentioning

confidence: 99%

Comparison of international medical costs for interventional pain treatment: a focus on Korea and Japan

Lee,

Won,

Yang

et al. 2023

Korean J Pain

View full text Add to dashboard Cite

Background The rise in national health care costs has emerged as a global problem given the ever-aging population and rapid development of medical technology. The utilization of interventional pain management has, similarly, shown a continued rise worldwide. This study evaluates the differences in the medical costs in the field of interventional pain treatment (IPT) between two countries Korea and Japan. Methods Korean medical insurance costs for 2019 related to pain management focused on IPT were compared to those of Japan. Purchasing power parity (PPP) was used to adjust the exchange rate differences and to compare prices in consideration of the respective societies’ economic power. Results The cost of trigger point injections in Japan was 1.06 times higher than that of Korea, whereas the perineural and intraarticular injection prices were lower in Japan. The cost of epidural blocks was higher in Japan compared to Korea in both cervical/thoracic and lumbar regions. As for blocks of peripheral branches of spinal nerves, the cost of scapular nerve blocks in Japan was lower than that in Korea, given a PPP ratio 0.09. For nerve blocks in which fluoroscopy guidance is mandatory, the costs of epidurography in Japan were greater than those in Korea, given a PPP ratio 1.04. Conclusions This is the first comparative study focusing on the medical costs related to IPT between Korea and Japan, which reveals that the costs differed along various categories. Further comparisons reflecting more diverse countries and socio-economic aspects will be required.

show abstract

Prediction of successful caudal epidural injection using color Doppler ultrasonography in the paramedian sagittal oblique view of the lumbosacral spine

Cited by 6 publications

References 24 publications

Color flow Doppler in spinal ultrasound: a novel technique for assessment of catheter position in labor epidurals

Color flow Doppler in spinal ultrasound: a novel technique for assessment of catheter position in labor epidurals

Diagnostic value of the posterior talofibular ligament area for chronic lateral ankle instability

Comparison of international medical costs for interventional pain treatment: a focus on Korea and Japan

Contact Info

Product

Resources

About