Keimyung University DongSan Hospital Department of Anesthesiology and Pain Medicine, Dalseo-gu, Daegu, Korea.
Pain Physician. 2022 Oct;25(7):E969-E975.
Inadvertent intravascular injection of local anesthetics can lead to false-negative results following lumbar medial branch block (MBB) performed to diagnose facet joint origin pain. A previous study demonstrated that the type of approach method could affect the incidence of intravascular injections and technical ease of the procedure.
The primary objective of our study was to compare the incidence of inadvertent intravascular injection and technical ease of the MBB between anteroposterior (AP) and oblique (OB) views.
Prospective randomized trial.
An interventional pain management practice in South Korea.
The incidence of intravascular uptake of contrast medium was compared using AP and OB fluoroscopic views during lumbar MBB. Injection time, radiation dose, and patient discomfort during lumbar MBB were also compared. Risk factors associated with a longer procedure time and a higher radiation dose were analyzed.
The incidence of intravascular injection was 22.5% (23/102) in the AP group and 17.6% (18/102) in the OB group (P = 0.382). A significantly longer injection time and a higher dose of radiation were required to complete 3 levels of MBB in the OB group than in the AP group (45.9 seconds vs 61.9 seconds, P = 0.001; 27.4 centigray [cGy]/cm2 vs 42.2 cGy/cm2, I = 0.004). The OB approach and left side injection were the risk factors associated with a longer total procedure time (odds ratio [OR] = 6.64, 95% CI, 1.99-22.17, P = 0.002; OR = 0.20, 95% CI, 0.06-0.67, P = 0.009, OB and AP, respectively).
The physician performing the MBB could recognize the AP or OB fluoroscopic view during procedure.
The overall incidence rate of intravascular injection during lumbar MBB showed nearly 20% in both approach methods groups. The OB approach and left side MBBs were associated with a longer total procedure time and a higher radiation dose.
局部麻醉药意外注入血管会导致腰椎内侧支阻滞（MBB）后诊断小关节源性疼痛的假阴性结果。先前的研究表明，进针方法的类型会影响血管内注射的发生率和操作的难易程度。
本研究的主要目的是比较前后位（AP）和斜位（OB）两种影像学方法下 MBB 中意外血管内注射的发生率和操作的难易程度。
前瞻性随机试验。
韩国介入性疼痛管理实践。
在腰椎 MBB 中比较使用 AP 和 OB 透视视图时造影剂的血管内摄取发生率。还比较了腰椎 MBB 的注射时间、辐射剂量和患者不适感。分析了与较长手术时间和较高辐射剂量相关的危险因素。
AP 组血管内注射发生率为 22.5%（23/102），OB 组为 17.6%（18/102）（P=0.382）。OB 组完成 3 个水平的 MBB 需要更长的注射时间和更高的辐射剂量（45.9 秒比 61.9 秒，P=0.001；27.4 厘戈瑞[ cGy ]/cm2 比 42.2 cGy/cm2 ，I=0.004）。OB 进针方法和左侧注射是总手术时间延长的危险因素（比值比[OR] = 6.64，95%置信区间，1.99-22.17，P=0.002；OR = 0.20，95%置信区间，0.06-0.67，P=0.009，OB 和 AP）。
行 MBB 的医生在操作过程中可以识别 AP 或 OB 透视视图。
两种进针方法下腰椎 MBB 中血管内注射的总体发生率均接近 20%。OB 进针方法和左侧 MBB 与总手术时间延长和辐射剂量增加有关。
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