An Operator’s Experience of the Loss-of-Resistance Technique in Epidural Injections: An Observational Study

Yıl: 2021 Cilt: 53 Sayı: 1 Sayfa Aralığı: 48 - 52 Metin Dili: İngilizce DOI: 10.5152/eurasianjmed.2021.20014 İndeks Tarihi: 28-06-2021

An Operator’s Experience of the Loss-of-Resistance Technique in Epidural Injections: An Observational Study

Öz:
Objective: A successful interlaminar epidural injection relies on correct epidural space needle placement.Most interlaminar epidural steroid injection (ESI) procedures are performed with a blind technique knownas loss-of-resistance (LOR) without an imaging guide. This study aims to evaluate the success rate of the LORtechnique in interlaminar epidural steroid injection under fluoroscopic control.Materials and Methods: Patients who underwent interlaminar ESI owing to a history of at least 3 monthsof chronic low back and leg pain not responding to medications and physical therapies were included in anobservational trial. Participants’ age was between 27 and 88 years, and they had an American Society of Anesthesiologists physical status of I–III. The patients were placed in a prone position, and a Tuohy needle wasintroduced at the level of the L5–S1 interlaminar foramen using fluoroscopic image with an anteroposteriorview. A lateral view was obtained when the LOR was felt. The procedures that achieved epidural spread bycontrast agent in the first attempt were deemed successful. Those that did not and those that had false positive LOR were regarded as unsuccessful.Results: Interlaminar ESİ was administered to 150 patients. The procedure’s success and failure rates were76% (114 patients) and 24% (36 patients), respectively. A total of 58.3% (21 patients) of patients who underwent an unsuccessful procedure had a false LOR, whereas 41.6% (15 patients) of the same group exhibitedother causes. Sex, age, and body mass index (BMI) showed no statistical significance in terms of proceduralsuccess. There were statistically significant differences in the distance between the skin and the epidural spaceaccording to the body mass index groups.Conclusion: The LOR technique identified the epidural space in most epidural procedures. However, insome cases, LOR was shown to be inadequate. Therefore, we suggest that the LOR technique must be supported by imaging such as fluoroscopy during epidural injections.
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Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Wynn MM, Mell MW, Tefera G, Hoch JR, Acher CW. Complications of spinal fluid drainage in thoracoabdominal aortic aneurysm repair: a report of 486 patients treated from 1987 to 2008. J Vasc Surg 2009; 49: 29-34.
  • 2. Kim JT, Bahk JH, Sung J. Influence of age and sex on position of the conus medullaris and Tuffier's line in adults. Anesthesiology 2003; 99: 1359-63.
  • 3. Duniec L, Nowakowski P, Kosson D, Lazowski T. Anatomical landmarks based assessment of intravertebral space level for lumbar puncture is misleading in more than 30%. Anaesthesiol Intensive Ther 2013; 45: 1-6.
  • 4. Karmakar MK, Li X, Ho AM, Kwok WH, Chui PT. Real-time ultrasound-guided paramedian epidural Access: evaluation of a novel in-plane technique. Br J Anaesth 2009; 102: 845-54.
  • 5. Botwin KP, Thomas S, Gruber RD, et al. Radiation exposure of the spinal interventionalist performing fluoroscopically guided lumbar transforaminal epidural steroid injections. Arch Phys Med Rehabil 2002; 83: 697-701.
  • 6. Grau T, Leipold RW, Conradi R, Martin E, Motsch J. Ultrasound imaging facilitates localization of the epidural space during combined spinal and epidural anesthesia. Reg Anesth Pain Med 2001; 26:64-7.
  • 7. Grau T, Leipold RW, Fatehi S, Martin E, Motsch J. Real-time ultrasonic observation of combined spinal-epidural anaesthesia. Eur J Anaesthesiol 2004; 21: 25-31.
  • 8. Lechner TJ, van Wijk MG, Maas AJ. Clinical results with a new acoustic device to identify the epidural space. Anaesthesia 2002; 57: 768-72.
  • 9. Lechner TJ, van Wijk MG, Jongenelis AA, Rybak M, van Niekerk J, Langenberg CJ. The use of a sound-enabled device to measure pressure during insertion of an epidural catheter in women in labour. Anaesthesia 2011; 66: 568-73.
  • 10. Habib AS, George RB, Allen TK, Olufolabi AJ. A pilot study to compare the Episure Autodetect syringe for identification of the epidural space in parturients. Anesth Analg 2008; 106: 541-3.
  • 11. Carassiti M, Quarta R, Mattei A, et al. Ex vivo animal-model assessment of a non-invasive system for loss of resistance detection during epidural blockade. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2017: 759-62.
  • 12. Capogna E, Coccoluto A, Gibiino G, Del Vecchio A. Compuflo®-Assisted Training vs Conventional Training for the Identification of the Ligamentum Flavum with an Epidural Simulator: A Brief Report. Anesthesiol Res Pract 2019; 2019: 3804743.
  • 13. Carassiti M, Cataldo R, Formica D, et al. A new pressure guided management tool for epidural space detection: feasibility assessment in a clinical scenario. Minerva Anestesiol 2020; 86: 736-41.
  • 14. Manchikanti L, Pampati V, Boswell MV, Smith HS, Hirsch JA. Analysis of the growth of epidural injections and costs in the Medicare population: a comparative evaluation of 1997, 2002, and 2006 data. BMC Health Serv Res 2010; 10: 84.
  • 15. Manchikanti L, Singh V, Falco FJE, Cash KA, Pampati V. Evaluation of the effectiveness of lumbar interlaminar epidural injections in managing chronic pain of lumbar disc herniation or radiculitis: a randomized, double-blind, controlled trial. Pain Physician 2010; 13: 343-55.
  • 16. Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth 2005; 94: 7-17.
  • 17. Gupta B, Sharma S, D'souza N, Kaur M. Pseudo loss of resistance in epidural space localization. Saudi J Anaesth 2010; 4: 117-8.
  • 18. White AH, Derby R, Wynne G. Epidural injection for the diagnosis and treatment of low back pain. Spine 1980; 5: 78-86.
  • 19. Tran QH, Gonzales AP, Bernucci F, Finlayson J. Confirmation of loss of resistance for epidural analgesia. Reg Anesth Pain Med 2015; 40: 166-73.
  • 20. De Filho GR, Gomes HP, da Fonseca MH, Hoffman JC, Pederneiras SG, Garcia JH. Predictors of successful neuraxial block: a prospective study. Eur J Anaesthesiol 2002; 19: 447-51.
  • 21. Bartynski WS, Grahovac SZ, Rothfus WE. Incorrect needle position during lumbar epidural steroid administration: inaccuracy of loss of air pressure resistance and requirement of fluoroscopy and epidurography during needle insertion. Am J Neuroradiol 2005; 26: 502-5.
  • 22. Liu SS, Melmed AP, Klos JW, Innis CA. Prospective experience with a 20-gauge Tuohy needle for lumbar epidural steroid injections: Is confirmation with fluoroscopy necessary? Reg Anesth Pain Med 2001; 26: 143-6.
  • 23. Wantman A, Hancox N, Howell PR. Techniques for identifying the epidural space: a survey of practice amongst anaesthetists in the UK. Anaesthesia 2006; 61: 370-5.
  • 24. Beilin Y, Arnold I, Telfeyan C, Bernstein H, Hossain S. Quality of analgesia when air versus saline is used for identification of the epidural space in the parturient. Reg Anesth Pain Med 2000; 25: 596-9.
  • 25. Vaira P, Camorcia M, Palladino T, Velardo M, Capogna G. Differentiating false loss of resistance from true loss of resistance while performing the epidural block with the CompuFlo® epidural instrument. Anesthesiol Res Pract 2019; 2019: 5185901.
  • 26. Qureshi AI, Khan AA, Malik AA, et al. Lumbar catheter placement using paramedian approach under fluoroscopic guidance. J Vasc Interv Neurol 2016; 8: 55-62.
  • 27. Park KD, Kim TK, Lee WY, Ahn J, Koh SH, Park Y. Ultrasound-guided versus fluoroscopy-guided caudal epidural steroid injection for the treatment of unilateral lower lumbar radicular pain: case-controlled, retrospective, comparative study. Medicine 2015; 94: e2261.
  • 28. Griffin J, Nicholls B. Ultrasound in regional anaesthesia. Anaesthesia 2010; 65 Suppl 1: 1-12.
  • 29. Marhofer P, Greher M, Kapral S. Ultrasound guidence in regional anaesthesia. Br J Anaesth 2005; 94: 7-17.
  • 30. Fredman B, Nun MB, Zohar E, et al. Epidural steroids for treating "failed back surgery syndrome": Is fluoroscopy really necessary? Anesth Analg 1999; 88: 367-72. 31. Shetty SK, Nelson EN, Lawrimore TM, Palmer WE. Use of gadolinium chelate to confirm epidural needle placement in patients with an iodinated contrast reaction. Skeletal Radiol 2007; 36: 301-7.
  • 32. Carvalho JCA. Ultrasound-facilitated epidurals and spinals in obstetrics. Anesthesiol Clin 2008; 26: 145-58.
  • 33. Palmer SK, Abram SE, Maitra AM, von Colditz H. Distance from the skin to the lumbar epidural space in an obstetric population. Anesth Analg 1983; 62: 944-6.
  • 34. Clinkscales CP, Greenfield MLVH, Vanarase M, Polley LS. An observational study of the relationship between lumbar epidural space depth and body mass index in Michigan parturients. Int J Obstet Anesth 2007; 16: 323-7.
APA Arici T (2021). An Operator’s Experience of the Loss-of-Resistance Technique in Epidural Injections: An Observational Study. , 48 - 52. 10.5152/eurasianjmed.2021.20014
Chicago Arici Tulin An Operator’s Experience of the Loss-of-Resistance Technique in Epidural Injections: An Observational Study. (2021): 48 - 52. 10.5152/eurasianjmed.2021.20014
MLA Arici Tulin An Operator’s Experience of the Loss-of-Resistance Technique in Epidural Injections: An Observational Study. , 2021, ss.48 - 52. 10.5152/eurasianjmed.2021.20014
AMA Arici T An Operator’s Experience of the Loss-of-Resistance Technique in Epidural Injections: An Observational Study. . 2021; 48 - 52. 10.5152/eurasianjmed.2021.20014
Vancouver Arici T An Operator’s Experience of the Loss-of-Resistance Technique in Epidural Injections: An Observational Study. . 2021; 48 - 52. 10.5152/eurasianjmed.2021.20014
IEEE Arici T "An Operator’s Experience of the Loss-of-Resistance Technique in Epidural Injections: An Observational Study." , ss.48 - 52, 2021. 10.5152/eurasianjmed.2021.20014
ISNAD Arici, Tulin. "An Operator’s Experience of the Loss-of-Resistance Technique in Epidural Injections: An Observational Study". (2021), 48-52. https://doi.org/10.5152/eurasianjmed.2021.20014
APA Arici T (2021). An Operator’s Experience of the Loss-of-Resistance Technique in Epidural Injections: An Observational Study. Eurasian Journal of Medicine, 53(1), 48 - 52. 10.5152/eurasianjmed.2021.20014
Chicago Arici Tulin An Operator’s Experience of the Loss-of-Resistance Technique in Epidural Injections: An Observational Study. Eurasian Journal of Medicine 53, no.1 (2021): 48 - 52. 10.5152/eurasianjmed.2021.20014
MLA Arici Tulin An Operator’s Experience of the Loss-of-Resistance Technique in Epidural Injections: An Observational Study. Eurasian Journal of Medicine, vol.53, no.1, 2021, ss.48 - 52. 10.5152/eurasianjmed.2021.20014
AMA Arici T An Operator’s Experience of the Loss-of-Resistance Technique in Epidural Injections: An Observational Study. Eurasian Journal of Medicine. 2021; 53(1): 48 - 52. 10.5152/eurasianjmed.2021.20014
Vancouver Arici T An Operator’s Experience of the Loss-of-Resistance Technique in Epidural Injections: An Observational Study. Eurasian Journal of Medicine. 2021; 53(1): 48 - 52. 10.5152/eurasianjmed.2021.20014
IEEE Arici T "An Operator’s Experience of the Loss-of-Resistance Technique in Epidural Injections: An Observational Study." Eurasian Journal of Medicine, 53, ss.48 - 52, 2021. 10.5152/eurasianjmed.2021.20014
ISNAD Arici, Tulin. "An Operator’s Experience of the Loss-of-Resistance Technique in Epidural Injections: An Observational Study". Eurasian Journal of Medicine 53/1 (2021), 48-52. https://doi.org/10.5152/eurasianjmed.2021.20014