Ma Ling, Wang Yi, Yao Ming, Huang Bing, Deng Jiajia, Wen Huaichang
Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, People's Republic of China.
Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, Wuhu, People's Republic of China.
J Pain Res. 2023 Mar 6;16:669-676. doi: 10.2147/JPR.S399431. eCollection 2023.
To verify the injectate dispersal patterns (IDP) and therapeutic outcome of ultrasound-guided cervical selective nerve root block (UG-SCNRB) in treating cervical radiculopathy (CR).
Overall, 18 CR patients were recruited to undergo UG-SCNRB in the CT room. Following placement of the puncture needle tip between the target nerve root and posterior tubercle, 3 mL of the drug was administered per root (0.33% lidocaine 0.5 mL + Compound betamethasone injection 0.5mL + methylcobalamin injection 1mL + iohexol 1mL). Subsequently, the IDP was assessed on postintervention CT scan images.
In all, 18 participants were analyzed. We injected 21 target cervical nerve roots, namely, 1 C4 nerve, 9 C5 nerves, and 11 C6 nerves. Among the IDPs on postintervention CT scan images, two IDPs were most prevalent, namely, the contrast spread into the extraforaminal spaces (Zone I, the interscalene) in 100% (21/21) of cases, and the foraminal space spread (Zone II) in 61.90% (13/21) of cases. The injectate spread into the epidural spaces (Zone III) in only 2 out of 21 cases (9.52%). The pain relief was significantly improved two hours after surgery, compared to the preoperative VAS pain scores (2 hours, 1.39±0.50 vs VAS at baseline, P<0.01). The VAS pain scores during follow-up were significantly lower than preoperation (1 weeks, 1.94±0.54 vs VAS at baseline; 2 weeks, 2.61±0.70, P<0.01 vs VAS at baseline; 4 weeks, 2.67±0.59, P<0.01 vs VAS at baseline).
We verified, via CT imaging, that the UG-SCNRB drug diffusion was within safe range (the injectate mainly spread to the extraforaminal spaces), and without any serious complications, such as, intravascular drug injection, extensive diffusion of the epidural space, and general spinal anesthesia.
验证超声引导下颈椎选择性神经根阻滞（UG-SCNRB）治疗神经根型颈椎病（CR）的注射剂扩散模式（IDP）和治疗效果。
共招募18例CR患者在CT室接受UG-SCNRB。将穿刺针尖端置于目标神经根与后结节之间后，每根神经根注射3 mL药物（0.33%利多卡因0.5 mL + 复方倍他米松注射液0.5mL + 甲钴胺注射液1mL + 碘海醇1mL）。随后，在干预后的CT扫描图像上评估IDP。
共分析了18名参与者。我们注射了21个目标颈神经根，即1个C4神经根、9个C5神经根和11个C6神经根。在干预后的CT扫描图像的IDP中，两种IDP最为常见，即造影剂扩散到椎间孔外间隙（I区，斜角肌间隙）的病例占100%（21/21），扩散到椎间孔间隙（II区）的病例占61.90%（13/21）。注射剂仅在21例中的2例（9.52%）扩散到硬膜外间隙（III区）。与术前视觉模拟评分法（VAS）疼痛评分相比，术后2小时疼痛缓解明显改善（2小时，1.39±0.50 vs 基线VAS，P<0.01）。随访期间的VAS疼痛评分明显低于术前（1周，1.94±0.54 vs 基线VAS；2周，2.61±0.70，与基线VAS相比P<0.01；4周，2.67±0.59，与基线VAS相比P<0.01）。
我们通过CT成像验证了UG-SCNRB药物扩散在安全范围内（注射剂主要扩散到椎间孔外间隙），且无任何严重并发症，如血管内药物注射、硬膜外间隙广泛扩散和全身脊髓麻醉。
