Won Sun Jae, Rhee Won Ihl, Yoon Joon Shik, Lee U-Young, Ko Young Jin
Departments of Physical Medicine and Rehabilitation (S.J.W., W.I.R., Y.J.K.) and Anatomy (U.-Y.L.), College of Medicine, Catholic University of Korea, Seoul, Korea; and Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea (J.S.Y.).
J Ultrasound Med. 2016 Feb;35(2):305-10. doi: 10.7863/ultra.15.02062. Epub 2016 Jan 6.
We aimed to estimate the spread of injections for ultrasound-guided cervical nerve root blocks and to determine the optimal injectate volume required in this procedure.
A total of 32 ultrasound-guided injections (C5-C8) were made in 4 fresh cadavers. The target on each cervical root was the space between the posterior tubercle and the cervical root at the most proximal location possible on the sonogram. After ultrasound-guided needle insertion, 0.5 mL of a contrast medium was injected 4 times. The dye flow patterns were confirmed with fluoroscopy each time, and we recorded whether the contrast medium reached the dorsal root ganglion level or the epidural space. After the injections, the needle tip location was determined by computed tomography and image reconstruction.
All injections produced typical neurograms. The contrast medium reached the dorsal root ganglion in 29 of 32 (90.6%) injections (mean ± SD, 0.84 ± 0.42 mL of contrast medium) and the epidural space in 10 of 32 (31.3%) injections (1.30 ± 0.54 mL of contrast medium). The mean distance between the needle tip and neural foramen was 9.64 ± 3.68 mm, and this distance correlated positively with the volume of contrast medium necessary to reach the dorsal root ganglion or the epidural space.
Ultrasound-guided cervical nerve root blocks show potential utility for targeting an anesthetic into the cervical root area. This study may be helpful for deciding the most appropriate volume for the procedure.
我们旨在评估超声引导下颈神经根阻滞注射的扩散情况，并确定该操作所需的最佳注射量。
在4具新鲜尸体上共进行了32次超声引导下的注射（C5 - C8）。每个颈神经根的目标是超声图像上尽可能近端的后结节与颈神经根之间的间隙。在超声引导下插入针后，分4次注射0.5 mL造影剂。每次用荧光透视确认染料流动模式，并记录造影剂是否到达背根神经节水平或硬膜外间隙。注射后，通过计算机断层扫描和图像重建确定针尖位置。
所有注射均产生典型的神经影像。32次注射中有29次（90.6%）造影剂到达背根神经节（平均±标准差，造影剂0.84±0.42 mL），32次注射中有10次（31.3%）造影剂到达硬膜外间隙（1.30±0.54 mL造影剂）。针尖与神经孔之间的平均距离为9.64±3.68 mm，该距离与到达背根神经节或硬膜外间隙所需的造影剂体积呈正相关。
超声引导下颈神经根阻滞在将麻醉剂靶向注入颈神经根区域方面显示出潜在的实用性。本研究可能有助于确定该操作的最合适剂量。
