초록접수[미리보기]
| 21KF-034 |
Predicting Epidural Space Spread Using Ultrasound Doppler Imaging in Interlaminar Epidural Steroid Injection
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Background: Transforaminal epidural steroid injection (TFESI) is performed more often than interlaminar epidural steroid injection (ILESI) because only 36% of ILESI attempts reach the anterior epidural space (AES). However, TFESI requires fluoroscopy and contrast dye, exposing the patients, medical staff, and operators to radiation. Moreover, patients are at risk of developing adverse reactions to contrast dye including headache, nausea, muscular pain, hypotension, and, more rarely, anaphylactic reactions. This study describes a novel technique employing color Doppler to help predict epidural space spread in ILESI.
Materials and Methods: This observational study prospectively enrolled 35 patients scheduled for lumbar epidural steroid injection (ESI). Ultrasound-guided epidural injection was conducted and real-time images using color Doppler were recorded during injections of 5 mL of 0.1% ropivacaine containing contrast dye with dexamethasone. Fluoroscopy-guided TFESI was performed if it was difficult to perform the procedure based on ultrasound images
Results: 35 patients were recruited for this study 5 of whom underwent fluoroscopy-guided TFESI due to poor ultrasound images. The remaining 30 patients underwent ultrasound-guided lateral parasagittal ILESI . The PPV was 84.6% (11 of 13) and the NPV was 100% (17). The sensitivity and specificity were 100% and 89.5%, respectively. The agreement was 93.3% (28 of 30) (Table 2). The quality of symptom improvement was rated as satisfactory in all patients. No complications were noted.
Conclusion: The main advantage of ultrasound-guided ILESI is the lack of radiation exposure and contrast medium requirement. Color Doppler may be a reliable imaging modality to predict epidural space spread during ultrasound-guided ILESI. It is worth predicting the spread in the AES by first attempting ultrasound-guided ESI. If the injectate has not spread to the AES, fluoroscopy-guided TFESI may be a good option after confirming the improvement of the patient\'s symptoms.
Materials and Methods: This observational study prospectively enrolled 35 patients scheduled for lumbar epidural steroid injection (ESI). Ultrasound-guided epidural injection was conducted and real-time images using color Doppler were recorded during injections of 5 mL of 0.1% ropivacaine containing contrast dye with dexamethasone. Fluoroscopy-guided TFESI was performed if it was difficult to perform the procedure based on ultrasound images
Results: 35 patients were recruited for this study 5 of whom underwent fluoroscopy-guided TFESI due to poor ultrasound images. The remaining 30 patients underwent ultrasound-guided lateral parasagittal ILESI . The PPV was 84.6% (11 of 13) and the NPV was 100% (17). The sensitivity and specificity were 100% and 89.5%, respectively. The agreement was 93.3% (28 of 30) (Table 2). The quality of symptom improvement was rated as satisfactory in all patients. No complications were noted.
Conclusion: The main advantage of ultrasound-guided ILESI is the lack of radiation exposure and contrast medium requirement. Color Doppler may be a reliable imaging modality to predict epidural space spread during ultrasound-guided ILESI. It is worth predicting the spread in the AES by first attempting ultrasound-guided ESI. If the injectate has not spread to the AES, fluoroscopy-guided TFESI may be a good option after confirming the improvement of the patient\'s symptoms.
|
|
