评估经中胸硬膜外腔入路的对侧斜位和侧位片：一项前瞻性观察研究。

Evaluation of Contralateral Oblique and Lateral Views for Mid-Thoracic Epidural Access: A Prospective Observational Study.

机构信息

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea.

出版信息

Pain Physician. 2021 Jan;24(1):E51-E59.

PMID:33400438

Abstract

BACKGROUND

The mid-thoracic region has been known to be the most difficult area when accessing epidural space despite using fluoroscopy. Contralateral oblique (CLO) view has been considered for use; however, it has not been evaluated in the mid-thoracic region.

OBJECTIVE

To evaluate the CLO view for mid-thoracic epidural access (TEA).

STUDY DESIGN

A prospective observational study.

SETTING

The study took place at a single pain clinic within a tertiary medical center in Seoul, Republic of Korea.

METHODS

A total of 30 patients participated in this study. After securing the mid-thoracic (T4-8) epidural space, fluoroscopic images were obtained. The needle tip location relative to the ventral interlaminar line (VILL), and the needle tip and laminar visualization were measured and analyzed on the CLO views at 40, 50, 60 degrees, and measured angle, and the lateral view.

RESULTS

The needle tip was clearly visualized in all CLO views, compared with the lateral view (100% vs. 36.7%, P < 0.001). The visualization of the laminar margin and the needle tip location on (or just anterior to) VILL using the CLO measured angle were significantly clearer compared with those in the CLO view at 40 and 50 degrees and the lateral view (laminar margin: 40°, 56.7% vs. 3.3%, P < 0.001; 50°, 56.7% vs. 26.7%, P = 0.012; 90°, 56.7% vs. 26.7%, P = 0.035; needle tip location: 40°, 96.7% vs. 26.7%, P < 0.001; 50°, 96.7% vs. 63.3%, P = 0.002; 90°, 96.7% vs. 66.7%, P = 0.012). There was no difference in these values between the CLO view at 60 degrees and CLO measured angle.

LIMITATIONS

Subjective and ambiguous criteria of evaluation may induce bias despite final measured values based on the consensus of an independent investigator.

CONCLUSION

A CLO view at 60 degrees and CLO measured angle view can provide clearer visualization and more consistent needle tip location than the lateral and other CLO angle views for mid-TEA. A CLO view at 60 degrees and CLO measured angle views could be used to identify the needle location and achieve success in mid-TEA.

摘要

背景

尽管使用透视，在中胸区域进入硬膜外腔仍然是最困难的部位。已经考虑使用对侧斜位（CLO）视图；然而，它尚未在中胸区域进行评估。

目的

评估对侧斜位（CLO）视图在中胸硬膜外入路（TEA）中的应用。

研究设计

前瞻性观察研究。

地点

这项研究在韩国首尔的一家三级医疗中心的一家单一疼痛诊所进行。

方法

共有 30 名患者参与了这项研究。在确认中胸（T4-8）硬膜外腔后，获得了透视图像。在 40、50、60 度的 CLO 视图上测量和分析针尖相对于腹侧椎间线（VILL）的位置以及针尖和椎板的可视化，并测量角度和侧位视图。

结果

与侧位视图相比（100%比 36.7%，P < 0.001），所有 CLO 视图中均清晰显示针尖。使用 CLO 测量角度的椎板边缘和针尖位置（或刚好在前部）的可视化明显比 40 度和 50 度 CLO 视图以及侧位视图更清晰（椎板边缘：40°，56.7%比 3.3%，P < 0.001；50°，56.7%比 26.7%，P = 0.012；90°，56.7%比 26.7%，P = 0.035；针尖位置：40°，96.7%比 26.7%，P < 0.001；50°，96.7%比 63.3%，P = 0.002；90°，96.7%比 66.7%，P = 0.012）。60 度 CLO 视图和 CLO 测量角度之间的这些值没有差异。