The Superiority of Contralateral Oblique View for Mid-thoracic Epidural Assess

Asan Medical Center

Status: Completed

Conditions: Postherpetic Neuralgia; Cancer; Herpes Zoster

Treatments: Procedure: Fluoroscopic-guided TEB

Study type: Interventional

Funder types: Other

Identifiers

NCT03789955

2018-1551

Details and patient eligibility

About

The aim of the present study is to compare contralateral oblique view with the lateral view for fluoroscopic guided mid-thoracic epidural assess.

Full description

A thoracic epidural assess (block or catheter insertion) is a widely used intervention to reduce pain in patients with postherpetic neuralgia or who underwent chest and upper abdominal surgery.

In order to achieve the correct procedure, accurate access to the thoracic epidural space is needed. However, a thoracic epidural assess is a relatively more difficult procedure than procedures used in other regions, because the spinous process of the thoracic vertebra is longer than that of the lumbar vertebra, and the area through which the needle can approach the epidural space is relatively smaller due to an acute angle and larger distance between the skin and the epidural space. The midthoracic region (T4-8) is the most difficult area when performing this procedure.

To overcome this issue, a method of approaching the thoracic epidural space through the contralateral oblique view (CLO view) has been introduced, however, unlike the cervical or lumbar spine, advantages of the CLO view over the lateral view or the optimal angle of the CLO view have not yet been studied. Therefore, we planned this study to investigate the advantages of the CLO view compared with the lateral view and to determine the optimal angles of the CLO view when fluoroscopic guided mid-thoracic epidural assess.

Enrollment: 30 patients

Sex: All

Ages: 20 to 79 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Scheduled for mid thoracic (T4-T8) epidural block or catheter insertion
• 20 ≤ age <80
• Presence of thoracic MRI or CT
• When obtaining informed consent voluntarily

Exclusion criteria

• Allergy to local anesthetics and contrast dye, and steroid
• Use of anticoagulants or antiplatelet medication, coagulopathy
• Infection at the insertion site
• Neurological or psychiatric disorders
• Prior spine instrumentation
• Pregnancy

Trial design

Primary purpose: Diagnostic

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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30 participants in 1 patient group

Fluoroscopic-guided TEB

Experimental group

Description:

After assessment of the epidural space using the loss of resistance technique with air under fluoroscopic guidance, six fluoroscopic views will be obtained: true anteroposterior, contralateral oblique (CLO) at 40 degrees, 50 degrees, 60 degrees, CLO measured, and lateral for comparison CLO view with lateral view.

Treatment:

Procedure: Fluoroscopic-guided TEB