Ultrasound-guided Caudal Epidural Injection

نویسندگان

  • Brian A. Williams
  • Admir Hadzic
چکیده

To the Editor:—I read with interest the article “Ultrasound Guidance in Caudal Epidural Needle Placement” by Chen et al. However, I have a couple of points to raise. The author’s assertion that the application of ultrasonography to locate the sacral hiatus for caudal epidural injections has not been described is inaccurate. The footprint property of the transducer is not mentioned in the article. The linear array transducer cannot be used in all patients. In obese patients, it is sometimes necessary to use a curvilinear array transducer with lower frequency ranges to achieve a sonographic image of reasonable quality. Similarly, in very thin individuals, a transducer with a smaller footprint is more appropriate. I agree with the authors regarding the advantage of using ultrasonography for caudal epidural needle placement. The article mentions the fact that ultrasound cannot provide us with the image information as to the depth of the inserted needle as the only disadvantage. It makes no mention of the most important limitation of this method, i.e., inadvertent intravascular injection. Inadvertent intravascular injection, which has been reported to occur in 5–9% of these procedures, cannot be avoided with this technique. This is important because aspiration or return of blood is neither sensitive nor specific for intravascular positioning of the needle. Toxic concentration of local anesthetic may occur on inadvertent injection into an epidural vein.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Caudal Epidural Steroid Injections in Postlaminectomy Patients: Comparison of Ultrasonography and Fluoroscopy.

AIM To compare the results of ultrasound and fluoroscopy guided caudal epidural steroid injections in postlaminectomy patients. MATERIAL AND METHODS Thirty postlaminectomy patients were randomly divided into two groups, Group I (n=15) received ultrasound-guided and Group II (n=15) received fluoroscopy-guided caudal epidural local anesthetic and steroid injection. Time of block for each patien...

متن کامل

A Comparison of Two Techniques for Ultrasound-guided Caudal Injection: The Influence of the Depth of the Inserted Needle on Caudal Block

BACKGROUND Caudal epidural injections have been commonly performed in patients with low back pain and radiculopathy. Although caudal injection has generally been accepted as a safe procedure, serious complications such as inadvertent intravascular injection and dural puncture can occur. The present prospective study was designed to investigate the influence of the depth of the inserted needle o...

متن کامل

Ultrasound guidance in caudal epidural needle placement.

BACKGROUND This study was conducted to investigate the feasibility of using ultrasound as an image tool to locate the sacral hiatus accurately for caudal epidural injections. METHODS Between August 2002 and July 2003, 70 patients (39 male and 31 female patients) with low back pain and sciatica were studied. Soft tissue ultrasonography was performed to locate the sacral hiatus. A 21-gauge caud...

متن کامل

Ultrasound-guided Caudal Epidural Injection

To the Editor:—I read with interest the article “Ultrasound Guidance in Caudal Epidural Needle Placement” by Chen et al. However, I have a couple of points to raise. The author’s assertion that the application of ultrasonography to locate the sacral hiatus for caudal epidural injections has not been described is inaccurate. The footprint property of the transducer is not mentioned in the articl...

متن کامل

Vertical Small-Needle Caudal Epidural Injection Technique

BACKGROUND Anecdotal evidence suggests that a vertical small-needle injection method enters the caudal epidural space with comparable efficacy to cephalad-directed methods, with less intravascular injection. OBJECTIVES Assess the success rate of vertical caudal epidural injection using epidurography and the frequency of intravascular injection using a vertical small-needle approach. PATIENT...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:

دوره   شماره 

صفحات  -

تاریخ انتشار 2005