Ultrasound guided caudal epidural injections in the management of disc-related sciatica: audit data from a spinal interface service

Objective: To assess the short-term efficacy of ultrasound-guided caudal epidural steroid injections (ESIs) in improving pain, and nerve function as measured by electrophysiological testing in chronic radicular low back pain. Methods: Patients diagnosed with chronic radicular low back pain were randomized into one of two groups. The injection group (n = 20) underwent a single ultrasound-guided Caudal ESI of 1 ml of 40 mg ml−1 Triamcinolone Acetonide (Kenacort-A), with local anesthetic. The control group (n = 20) underwent a 12-session physiotherapy program. Both groups were evaluated before and 2 weeks after the intervention using visual analog scale for pain and electrophysiological testing comprising peroneal and tibial terminal motor latencies and F-response latencies and chronodispersion. Results: Both groups showed significant pain reduction on the visual analog scale after the intervention. The injection group showed a significant reduction in F wave chronodispersion post-treatment (<0.01). In the control group, there were no significant differences in F wave parameters pre- and post-treatment (p > 0.05). Conclusion: Caudal ESIs were shown to provide short-term improvement of nerve function as evident by improvement in the electrophysiological parameters sensitive to radiculopathy. It was found to be superior to standard physical therapy in this regard. Advances in knowledge: This work shows a novel electrophysiologic evidence of the short-term efficacy ultrasound-guided caudal ESI.

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Assessment of effectiveness of percutaneous adhesiolysis and caudal epidural injections in managing post lumbar surgery syndrome: 2-year follow-up of a randomized, controlled trial

Journal of Pain Research ◽

10.2147/jpr.s38999 ◽

2012 ◽

pp. 597 ◽

Cited By ~ 28

Author(s):

Laxmaiah Manchikanti ◽

Vijay Singh ◽

Kimberly A Cash ◽

Pampati

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Lumbar Surgery ◽

Epidural Injections ◽

Randomized Controlled ◽

Caudal Epidural

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Proposed Ionizing Radiation Doses of 3711 Fluoroscopy-Guided Epidural Injections

10.22541/au.161545792.21587393/v1 ◽

2021 ◽

Author(s):

Rekib Sacaklidir ◽

Ekim Can Ozturk ◽

Savas Sencan ◽

Osman Hakan Gunduz

Keyword(s):

Ionizing Radiation ◽

Imaging Techniques ◽

Epidural Injection ◽

Critical Issue ◽

University Hospital ◽

Epidural Injections ◽

Epidural Steroid Injections ◽

Dose Levels ◽

Interlaminar Epidural Injection ◽

Caudal Epidural

Background: Since fluoroscopy-guided interventional therapies grew significantly in recent years, exposure to ionizing radiation (IR) either for patient or medical staff became a critical issue. IR exposure varies according to the physicians’ experience, patients’ body mass index (BMI), imaging techniques and type of the procedure performed. The purpose of this study is to calculate the reference IR doses for fluoroscopy-guided epidural injections per procedure and BMI to provide reference doses for potential use in future dose reduction strategies. Methods: A retrospectively, evaluation of patients who received epidural steroid injections between January 2015 and December 2020 in a university hospital interventional pain management center, was performed. This observational study was conducted with patients aged  18 who underwent 3711 epidural injections including cervical interlaminar, lumbar interlaminar, lumbar transforaminal and caudal approaches. Provided IR doses for each patient were also divided by patients’ BMI to obtain dose per BMI. Results: The highest IR dose per procedure was found in caudal epidural injection with 0.218 mGy m2 and lowest dose was in cervical interlaminar epidural injection with 0.057 mGy m2. The IR dose per procedure was 0.123 mGy m2 for lumbar transforaminal and 0.191 mGy m2 for lumbar interlaminar epidural injection. Caudal epidural injection had also the highest IR dose per BMI which was 0.00749 and cervical interlaminar epidural injection had the lowest radiation dose per BMI which was 0.00214. Conclusions: We proposed reference IR dose levels of four approaches of epidural injections obtained from 3711 injections performed in a university hospital pain medicine clinic. BMI of patients were taken into account with the dose levels of injections given per BMI. Multicenter research with standardized techniques will assure more reliable reference levels which will guide pain physicians to self-assess their own levels of radiation exposure.

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No Going Back: Advantages of Ultrasound-Guided Upper Arm PICC Placement

Journal of the Association for Vascular Access ◽

10.2309/java.13-4-6 ◽

2008 ◽

Vol 13 (4) ◽

pp. 191-197 ◽

Cited By ~ 24

Author(s):

Liz Simcock

Keyword(s):

Success Rate ◽

Ultrasound Guided ◽

Upper Arm ◽

Exit Site Infection ◽

Catheter Migration ◽

Audit Data ◽

Change In Practice ◽

Before And After ◽

The Usa ◽

The Uk

Abstract Background, Method and Purpose: The use of peripherally inserted central catheters (PICCs) in the UK has been steadily increasing since they were first introduced in 1995. Ultrasound-guided upper arm placement - which has become prevalent in the USA over the last few years - is gradually attracting interest amongst PICC placers in the UK. The literature shows that upper arm placement improves insertion success rate (Hockley, Hamilton, Young, Chapman, Taylor, Creed et al, 2007; Hunter, 2007; Krstenic, Brealey, Gaikwad & Maraveyas, 2008) and patient satisfaction (Polak, Anderson, Hagspiel, & Mungovan, 1998; Sansivero, 2000; McMahon, 2002). Following a switch to upper arm placement at her institution, the author examined audit data from before and after the change in practice to see if there were other measurable clinical improvements. Results: Comparison of data from a four-year period shows that upper arm placement in our patient population increased insertion success rate and line longevity, while reducing exit site infection, thrombosis and catheter migration. Implications for Practice: This data shows that ultrasound-guided upper-arm placement improves patient outcomes. PICC placers still using the more traditional antecubital approach should consider a change in practice.

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Ultrasound-Guided Caudal Epidural Block for Bilateral Testicular Ectopy and Circumcision in Child above 6 Years with Joubert Syndrome

Journal of Pediatrics & Child Health Care ◽

10.26420/jpediatrchildhealthcare.2021.1040 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Fekih Hassen Amjed ◽

◽

Ben Fraj Asma ◽

Blaiti Hajer ◽

Ben Slimen Ahmed ◽

...

Keyword(s):

Respiratory Control ◽

Perioperative Period ◽

Joubert Syndrome ◽

Epidural Block ◽

Opioid Use ◽

Ultrasound Guided ◽

Polygraphic Recordings ◽

Caudal Epidural Block ◽

Anesthesia Technique ◽

Caudal Epidural

Background: Abnormal respiratory control has been clearly documented in infants and children with Joubert Syndrome (JS) by polygraphic recordings, characterized by episodes of apnea, tachypnea, and/or hyperpnea and the risk of recurrence of these episodes increase probably in perioperative period. In those cases, the choice of anesthesia technique and postoperative pain protocol, constitute a challenge for anesthesiologists. Case: We describe a case of successful ultrasound-guided Caudal Epidural Block (CEB) for children above 6 years with Joubert Syndrome undergoing bilateral testicular ectopy and circumcision avoiding opioid-use. Conclusions: Despite the difficulty to achieve CEB in child above 6 years, the ultrasound-guided can increase the success providing effective analgesia in-patient with a high-risk of respiratory failure as child with JS.

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