OBJECTIVES: To investigate the accuracy of placement of epidural injections using the lumbar and caudal approaches. To identify which factors, if any, predicted successful placement. METHODS: 200 consecutive patients referred to a pain clinic for an epidural injection of steroid were randomly allocated to one of two groups. Group L had a lumbar approach to the epidural space and group C a caudal approach to the epidural space. Both groups then had epidurography performed using Omnipaque and an image intensifier to determine the position of the needle. RESULTS: Body mass index (BMI), grade of operator, and route of injection were predictors of a successful placement. 93% of lumbar and 64% of caudal epidural injections were correctly placed (p< 0.001). 97% of lumbar and 85% of caudal epidural injections clinically thought to be correctly placed were confirmed radiographically. For epidural injections where the clinical impression was 'maybe', 91% of lumbar injections, but only 45% of caudal injections were correctly placed. Obesity was associated with a reduced chance of successful placement (odds ratio (OR) 0.34 (95% confidence interval (CI) 0.17 to 0.72) BMI >30 v BMI <30). A more senior grade of operator was associated with a reduced chance of successful placement (OR 0.16 (95% CI 0.03 to 0.89) consultant v other). However, small numbers may have accounted for the latter result. CONCLUSIONS: The weight of the patient and intended approach need to be considered when deciding the method used to enter the epidural space. In the non-obese patient, lumbar epidural injections can be accurately placed without x ray screening, but caudal epidural injections, to be placed accurately, require x ray screening no matter what the weight of the patient Keywords : Analysis of Variance,Body Mass Index,Cauda Equina,classification,Clinical Competence,Epidural Space,Female,Hospitals,Humans,Injections,Injections,Epidural,Lumbosacral Plexus,Male,Medical Staff,Hospital,methods,Middle Aged,Obesity,Odds Ratio,Pain,Pain Management,Patients,standards,Treatment Outcome,, Caudal,Lumbar, prescription topical cream for nerve pain
Date of Publication : 2000 Nov
Authors : Price CM;Rogers PD;Prosser AS;Arden NK;
Organisation : Department of Pain Management, Portsmouth Hospitals NHS Trust, UK. Cathyprice@freeuk.com
Journal of Publication : Ann Rheum Dis
Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/11053065
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