게시판
| 21KS-017 |
Comparison of Contralateral Oblique View with the Lateral View for Mid-Thoracic Epidural Access
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine
Abstract
Background
Accessing the mid-thoracic epidural space has been challenging despite using fluoroscopy. The limitations of fluoroscopic lateral view, the contralateral oblique (CLO) view has been recommended. A previous study shows that CLO view at 60 degrees can be optimal angle for mid-thoracic epidural access, but the evidence of CLO view’s utility in the mid-thoracic region is lack. Thus, we aimed to evaluate the clinical usefulness of the CLO view at 60 degrees compared with lateral view when accessing mid-thoracic epidural space.
Methods
Patients were randomly allocated to receive mid-thoracic epidural access (mid-TEA) under the fluoroscopic lateral view (group L) or CLO view (group C). The primary outcome was the first attempt success rate of mid-TEA. The secondary outcomes were patient satisfaction and procedural pain intensity. Other outcomes measures included needling time, number of needle passes, and procedure-related complications.
Results
The seventy-nine patients (38 patients in group L and 41 patients in group C) participated in this study. First attempt success rate was significantly higher in group C than in group L (68.3% vs. 34.2%, P=0.003, relative risk (RR), 2.075, 95% confidence interval (95% CI), 1.253were significantly lower in group C compared to group L, respectively (3.0 [2.06.0ling time and number of needles passes were significantly less in group C over group L (95.0 [84.011; 1.0 (1.0 Cumulative total radiation dose in group C was significantly reduced than that in group L (59.3±35.0 vs. 88.5±71.2 cGy x cm2, P=0.026). One case of the vasovagal reaction occurred in group C, and there were no serious complications in both groups.
Conclusion
Considering superior clinical utilities of CLO view at 60 degrees during the mid-TEA, CLO view at 60 degrees may be primarily considered the optimal view for achieving the effective and safe mid-TEA.
Background
Accessing the mid-thoracic epidural space has been challenging despite using fluoroscopy. The limitations of fluoroscopic lateral view, the contralateral oblique (CLO) view has been recommended. A previous study shows that CLO view at 60 degrees can be optimal angle for mid-thoracic epidural access, but the evidence of CLO view’s utility in the mid-thoracic region is lack. Thus, we aimed to evaluate the clinical usefulness of the CLO view at 60 degrees compared with lateral view when accessing mid-thoracic epidural space.
Methods
Patients were randomly allocated to receive mid-thoracic epidural access (mid-TEA) under the fluoroscopic lateral view (group L) or CLO view (group C). The primary outcome was the first attempt success rate of mid-TEA. The secondary outcomes were patient satisfaction and procedural pain intensity. Other outcomes measures included needling time, number of needle passes, and procedure-related complications.
Results
The seventy-nine patients (38 patients in group L and 41 patients in group C) participated in this study. First attempt success rate was significantly higher in group C than in group L (68.3% vs. 34.2%, P=0.003, relative risk (RR), 2.075, 95% confidence interval (95% CI), 1.253were significantly lower in group C compared to group L, respectively (3.0 [2.06.0ling time and number of needles passes were significantly less in group C over group L (95.0 [84.011; 1.0 (1.0 Cumulative total radiation dose in group C was significantly reduced than that in group L (59.3±35.0 vs. 88.5±71.2 cGy x cm2, P=0.026). One case of the vasovagal reaction occurred in group C, and there were no serious complications in both groups.
Conclusion
Considering superior clinical utilities of CLO view at 60 degrees during the mid-TEA, CLO view at 60 degrees may be primarily considered the optimal view for achieving the effective and safe mid-TEA.