Influence of needle-insertion depth on epidural spread and clinical outcomes in caudal epidural injections: A randomized clinical trial

Sang Jun Park, Kyung Bong Yoon, Dong Ah Shin, Kiwook Kim, Tae Lim Kim, Shin Hyung Kim

Research output: Contribution to journalArticle

Abstract

Background: A caudal epidural steroid injection (CESI) is a commonly used method to improve symptoms of lumbosacral pain. We compared the achievement of successful epidurograms and patient-reported clinical outcomes following different needle-insertion depths during CESI. Methods: For the conventional method group, the needle was advanced into the sacral canal. For the alternative method group, the needle was positioned immediately after penetration of the sacrococcygeal ligament. Epidural filling patterns and vascular uptake during fluoroscopy were determined to verify successful epidural injection. Procedural pain scores were investigated immediately after the procedure. Pain scores and patient global impression of symptom change were evaluated at 1-month follow-up. Results: Assessments were completed by 127 patients (conventional method, n=64; alternative method, n=63). The incidence of intravascular injection was significantly lower in the alternative method group than in the conventional method group (3.2% vs 20.3%, P=0.005). Procedural pain during needle insertion was significantly lower in the alternative method group (3.7±1.3 vs 5.3±1.2, P<0.001). Epidural contrast filling patterns were similar in both groups. One-month follow-up pain scores and patient global impression of symptom change were comparable in both groups. Conclusion: Compared with the conventional method, the alternative method for CESI could achieve similar epidural spread and symptom improvement. The alternative technique exhibited clinical benefits of a lower rate of intravascular injection and less procedural pain.

Original languageEnglish
Pages (from-to)2961-2967
Number of pages7
JournalJournal of Pain Research
Volume11
DOIs
Publication statusPublished - 2018 Jan 1

Fingerprint

Epidural Injections
Needles
Randomized Controlled Trials
Pain
Steroids
Injections
Fluoroscopy
Ligaments
Blood Vessels

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

Cite this

Park, Sang Jun ; Yoon, Kyung Bong ; Shin, Dong Ah ; Kim, Kiwook ; Kim, Tae Lim ; Kim, Shin Hyung. / Influence of needle-insertion depth on epidural spread and clinical outcomes in caudal epidural injections : A randomized clinical trial. In: Journal of Pain Research. 2018 ; Vol. 11. pp. 2961-2967.
@article{2c409cb4de814d86bbcfb1360c46bcc1,
title = "Influence of needle-insertion depth on epidural spread and clinical outcomes in caudal epidural injections: A randomized clinical trial",
abstract = "Background: A caudal epidural steroid injection (CESI) is a commonly used method to improve symptoms of lumbosacral pain. We compared the achievement of successful epidurograms and patient-reported clinical outcomes following different needle-insertion depths during CESI. Methods: For the conventional method group, the needle was advanced into the sacral canal. For the alternative method group, the needle was positioned immediately after penetration of the sacrococcygeal ligament. Epidural filling patterns and vascular uptake during fluoroscopy were determined to verify successful epidural injection. Procedural pain scores were investigated immediately after the procedure. Pain scores and patient global impression of symptom change were evaluated at 1-month follow-up. Results: Assessments were completed by 127 patients (conventional method, n=64; alternative method, n=63). The incidence of intravascular injection was significantly lower in the alternative method group than in the conventional method group (3.2{\%} vs 20.3{\%}, P=0.005). Procedural pain during needle insertion was significantly lower in the alternative method group (3.7±1.3 vs 5.3±1.2, P<0.001). Epidural contrast filling patterns were similar in both groups. One-month follow-up pain scores and patient global impression of symptom change were comparable in both groups. Conclusion: Compared with the conventional method, the alternative method for CESI could achieve similar epidural spread and symptom improvement. The alternative technique exhibited clinical benefits of a lower rate of intravascular injection and less procedural pain.",
author = "Park, {Sang Jun} and Yoon, {Kyung Bong} and Shin, {Dong Ah} and Kiwook Kim and Kim, {Tae Lim} and Kim, {Shin Hyung}",
year = "2018",
month = "1",
day = "1",
doi = "10.2147/JPR.S182227",
language = "English",
volume = "11",
pages = "2961--2967",
journal = "Journal of Pain Research",
issn = "1178-7090",
publisher = "Dove Medical Press Ltd.",

}

Influence of needle-insertion depth on epidural spread and clinical outcomes in caudal epidural injections : A randomized clinical trial. / Park, Sang Jun; Yoon, Kyung Bong; Shin, Dong Ah; Kim, Kiwook; Kim, Tae Lim; Kim, Shin Hyung.

In: Journal of Pain Research, Vol. 11, 01.01.2018, p. 2961-2967.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Influence of needle-insertion depth on epidural spread and clinical outcomes in caudal epidural injections

T2 - A randomized clinical trial

AU - Park, Sang Jun

AU - Yoon, Kyung Bong

AU - Shin, Dong Ah

AU - Kim, Kiwook

AU - Kim, Tae Lim

AU - Kim, Shin Hyung

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: A caudal epidural steroid injection (CESI) is a commonly used method to improve symptoms of lumbosacral pain. We compared the achievement of successful epidurograms and patient-reported clinical outcomes following different needle-insertion depths during CESI. Methods: For the conventional method group, the needle was advanced into the sacral canal. For the alternative method group, the needle was positioned immediately after penetration of the sacrococcygeal ligament. Epidural filling patterns and vascular uptake during fluoroscopy were determined to verify successful epidural injection. Procedural pain scores were investigated immediately after the procedure. Pain scores and patient global impression of symptom change were evaluated at 1-month follow-up. Results: Assessments were completed by 127 patients (conventional method, n=64; alternative method, n=63). The incidence of intravascular injection was significantly lower in the alternative method group than in the conventional method group (3.2% vs 20.3%, P=0.005). Procedural pain during needle insertion was significantly lower in the alternative method group (3.7±1.3 vs 5.3±1.2, P<0.001). Epidural contrast filling patterns were similar in both groups. One-month follow-up pain scores and patient global impression of symptom change were comparable in both groups. Conclusion: Compared with the conventional method, the alternative method for CESI could achieve similar epidural spread and symptom improvement. The alternative technique exhibited clinical benefits of a lower rate of intravascular injection and less procedural pain.

AB - Background: A caudal epidural steroid injection (CESI) is a commonly used method to improve symptoms of lumbosacral pain. We compared the achievement of successful epidurograms and patient-reported clinical outcomes following different needle-insertion depths during CESI. Methods: For the conventional method group, the needle was advanced into the sacral canal. For the alternative method group, the needle was positioned immediately after penetration of the sacrococcygeal ligament. Epidural filling patterns and vascular uptake during fluoroscopy were determined to verify successful epidural injection. Procedural pain scores were investigated immediately after the procedure. Pain scores and patient global impression of symptom change were evaluated at 1-month follow-up. Results: Assessments were completed by 127 patients (conventional method, n=64; alternative method, n=63). The incidence of intravascular injection was significantly lower in the alternative method group than in the conventional method group (3.2% vs 20.3%, P=0.005). Procedural pain during needle insertion was significantly lower in the alternative method group (3.7±1.3 vs 5.3±1.2, P<0.001). Epidural contrast filling patterns were similar in both groups. One-month follow-up pain scores and patient global impression of symptom change were comparable in both groups. Conclusion: Compared with the conventional method, the alternative method for CESI could achieve similar epidural spread and symptom improvement. The alternative technique exhibited clinical benefits of a lower rate of intravascular injection and less procedural pain.

UR - http://www.scopus.com/inward/record.url?scp=85058870946&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058870946&partnerID=8YFLogxK

U2 - 10.2147/JPR.S182227

DO - 10.2147/JPR.S182227

M3 - Article

AN - SCOPUS:85058870946

VL - 11

SP - 2961

EP - 2967

JO - Journal of Pain Research

JF - Journal of Pain Research

SN - 1178-7090

ER -