Department of Anesthesiology and Pain Medicine, Keimyung University School of Medicine, Republic of Korea.
Keimyung University School of Medicine Republic of Korea.
Pain Physician. 2020 Mar;23(2):E203-E210.
During lumbar epidural injection (LEI) using a midline approach, we might encounter failure of identifying the epidural space owing to an equivocal or absent loss of resistance (LOR) sensation. The reason for such absence of LOR sensation has been suggested as paucity of midline ligamentum flavum, paravertebral muscle, and cyst in the interspinous ligament of the lumbar spine. Despite its low specificity, LOR is the most commonly used method to identify the epidural space.
The purpose of this study was to analyze lumbar epidural pressure decrease patterns and identify factors contributing to this pressure decrease.
Prospective randomized trial.
An interventional pain management practice in South Korea.
This prospective study included 104 patients receiving LEI due to lumbar radiculopathy. A midline or paramedian approach of LEI was determined with randomization. Among various factors, gender, age, body mass index (BMI), and diagnosis were analyzed using a subgroup that included 60 cases of only a paramedian approach.
Grades I, II (abrupt decrease), and III (gradual decrease) were found as patterns of epidural pressure decrease. Abrupt pressure decrease was more frequently observed in the paramedian group (P < 0.001). Age, gender, BMI, and diagnosis did not show any significant difference in frequencies between abrupt and gradual pressure decrease.
We could not match LOR sensation with epidural pressure decrease shown in the monitor.
This study demonstrates that abrupt pressure decrease occurs more frequently with the paramedian approach. However, age, gender, BMI, or diagnosis did not affect the incidence of epidural pressure decrease.
Epidural, paramedian, midline, pressure decrease.
在使用中线入路进行腰椎硬膜外注射（LEI）时，由于无法确定硬膜外间隙，可能会出现阻力感觉丧失（LOR）不明确或缺失的情况。这种 LOR 感觉缺失的原因被认为是中线上的黄韧带、椎旁肌肉和腰椎棘突间韧带中的囊肿稀少。尽管 LOR 的特异性较低，但它是最常用于确定硬膜外间隙的方法。
本研究旨在分析腰椎硬膜外压力下降模式，并确定导致这种压力下降的因素。
前瞻性随机试验。
韩国一家介入性疼痛管理诊所。
这项前瞻性研究纳入了 104 例因腰椎神经根病接受 LEI 的患者。通过随机分组确定 LEI 的中线或旁线入路。在各种因素中，对性别、年龄、体重指数（BMI）和诊断进行了分析，包括仅采用旁线入路的 60 例亚组。
发现硬膜外压力下降的模式为 I 级、II 级（突然下降）和 III 级（逐渐下降）。在旁线组中，突然压力下降更为常见（P < 0.001）。年龄、性别、BMI 和诊断在突然和逐渐压力下降的频率之间没有显示出任何显著差异。
我们无法将 LOR 感觉与监测器上显示的硬膜外压力下降相匹配。
本研究表明，旁线入路时更常出现突然压力下降。然而，年龄、性别、BMI 或诊断并不影响硬膜外压力下降的发生率。
硬膜外、旁线、中线、压力下降。
