Kwon Won Kyoung, Kim Ah Na, Lee Pil Moo, Park Cheol Hwan, Kim Jae Hun
Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Neungdong-ro 120-1, Kwangjin-gu, Seoul 05030, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Wondang OK Pain Clinic, 783 Hoguk-ro, Deogyang-gu, Goyang-si, Gyeonggi-do 10461, Republic of Korea.
Pain Res Manag. 2016;2016:4158291. doi: 10.1155/2016/4158291. Epub 2016 Apr 24.
Background. Caudal epidural steroid injections (CESIs) are an effective treatment for pain. If the injection spreads in a specific pattern depending on the needle position or bevel direction, it would be possible to inject the agent into a specific and desired area. Objectives. We conducted a prospective randomized trial to determine if the needle position and bevel direction have any effect on the epidural spreading pattern in CESI. Methods. Demographic data of the patient were collected. During CESI, the needle position (middle or lateral) and direction (ventral or dorsal) were randomly allocated. Following fluoroscope-guided injection of 4 mL contrast media and 10 mL of injectates, the epidural spreading patterns (ventral or dorsal, bilateral or lateral) were imaged. Results. In the 210 CESIs performed, the needle tip position and bevel direction did not influence the epidural spreading patterns at L4-5 and L5-S1 disc levels. A history of Lumbar spine surgery was associated with a significantly limited spread to each disc level. A midline needle tip position was more effective than the lateral position in spreading to the distant disc levels. Conclusions. Neither the needle tip position nor the bevel direction affected the epidural drug spreading pattern during CESI.
背景。骶管硬膜外类固醇注射（CESIs）是一种有效的疼痛治疗方法。如果注射剂根据针的位置或斜面方向以特定模式扩散，那么将药物注射到特定的期望区域将成为可能。目的。我们进行了一项前瞻性随机试验，以确定针的位置和斜面方向对骶管硬膜外类固醇注射中硬膜外扩散模式是否有任何影响。方法。收集患者的人口统计学数据。在骶管硬膜外类固醇注射期间，针的位置（中间或外侧）和方向（腹侧或背侧）被随机分配。在荧光镜引导下注射4毫升造影剂和10毫升注射剂后，对硬膜外扩散模式（腹侧或背侧、双侧或单侧）进行成像。结果。在进行的210次骶管硬膜外类固醇注射中，针尖端位置和斜面方向在L4 - 5和L5 - S1椎间盘水平不影响硬膜外扩散模式。腰椎手术史与每个椎间盘水平的扩散明显受限有关。中线针尖端位置在扩散到远处椎间盘水平方面比外侧位置更有效。结论。在骶管硬膜外类固醇注射期间，针尖端位置和斜面方向均不影响硬膜外药物扩散模式。
