Analysis of epidural waveform for cervical epdiural steroid injections confirmed with fluoroscopy

Department
Dept. of Anesthesiology & Pain Medicine (마취통증의학); Dept. of Psychiatry (정신건강의학)
Issue Date
2018
Citation
MEDICINE, Vol.97(13) : e0202-e0202, 2018
ISSN
0025-7974
Abstract
The identification of epidural space with loss of resistance (LOR) is commonly performed. But it lacks specificity. Epidural pressure waveform analysis (EPWA) provides a simple confirmative adjunct for LOR. If the needle is located within the epidural space, measurement of the pressure at its tips shows a pulsatile waveform. Previous studies demonstrated satisfactory sensitivity and specificity of EPWA. However, success or failure of epidural injection was confirmed by the pinprick test, which is limited for patients in the setting of the pain clinic. In this study, we evaluated the sensitivity, specificity, as well as positive and negative predictive values of EPWA for cervical epidural steroid injection (CESI) confirmed by fluoroscopy.One hundred and five CESIs of 75 patients suffering from neck and radicular arm pain of over 3 months duration were enrolled. The physician injected 5 mL of normal saline after a feeling of satisfactory LOR. Saline filled extension tubing, connected to a pressure transducer, was attached to the needle. A 3 mL bolus of contrast medium was injected to confirm the success of CESI.The incorrect identification of epidural space with LOR (false LOR) was 29.5%. Of these 31 failed CESIs, 2 showed epidural waveform and 29 did not. The sensitivity, specificity, positive and negative predictive value of EPWA was 94.5%, 93.5%, 97.2%, and 87.7%, respectively.EPWA shows satisfactory reliability and is a simple adjunct to decrease false LOR for CESI. Further confirmative studies are required before its routine use in clinical practice.
Keywords
cervicalepidural waveformloss of resistance
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/41067
Appears in Collections:
1. Journal Papers (연구논문) > 1. School of Medicine (의과대학) > Dept. of Anesthesiology & Pain Medicine (마취통증의학)
1. Journal Papers (연구논문) > 1. School of Medicine (의과대학) > Dept. of Psychiatry (정신건강의학)
Keimyung Author(s)
홍지희; 정성원
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