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. 2018 Nov 21:11:2961-2967.
doi: 10.2147/JPR.S182227. eCollection 2018.

Influence of needle-insertion depth on epidural spread and clinical outcomes in caudal epidural injections: a randomized clinical trial

Sang Jun Park  1   2 , Kyung Bong Yoon  1   2 , Dong Ah Shin  3 , Kiwook Kim  1 , Tae Lim Kim  1 , Shin Hyung Kim  1   2
Affiliations

Influence of needle-insertion depth on epidural spread and clinical outcomes in caudal epidural injections: a randomized clinical trial

Sang Jun Park et al. J Pain Res. .

Abstract

Background: A caudal epidural steroid injection (CESI) is a commonly used method to improve symptoms of lumbosacral pain. We compared the achievement of successful epidurograms and patient-reported clinical outcomes following different needle-insertion depths during CESI.

Methods: For the conventional method group, the needle was advanced into the sacral canal. For the alternative method group, the needle was positioned immediately after penetration of the sacrococcygeal ligament. Epidural filling patterns and vascular uptake during fluoroscopy were determined to verify successful epidural injection. Procedural pain scores were investigated immediately after the procedure. Pain scores and patient global impression of symptom change were evaluated at 1-month follow-up.

Results: Assessments were completed by 127 patients (conventional method, n=64; alternative method, n=63). The incidence of intravascular injection was significantly lower in the alternative method group than in the conventional method group (3.2% vs 20.3%, P=0.005). Procedural pain during needle insertion was significantly lower in the alternative method group (3.7±1.3 vs 5.3±1.2, P<0.001). Epidural contrast filling patterns were similar in both groups. One-month follow-up pain scores and patient global impression of symptom change were comparable in both groups.

Conclusion: Compared with the conventional method, the alternative method for CESI could achieve similar epidural spread and symptom improvement. The alternative technique exhibited clinical benefits of a lower rate of intravascular injection and less procedural pain.

Keywords: caudal block; epidurogram; fluoroscopy; intravascular injection; pain; sacral canal.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
The CONSORT flow diagram.
Figure 2
Figure 2
Schematic diagram and fluoroscopic images demonstrating needle placement of (A) the conventional method and (B) the alternative method for caudal epidural injection. Note: S3, third vertebral body of sacral spine; arrowheads indicate the tip of the needle.
Figure 3
Figure 3
Changes in pain scores during the study period. Notes: Values are expressed as mean±SD. *P<0.05 vs baseline in each group. There was no significant difference in pain scores between the two groups at 1 month after injection (P=0.333). Abbreviation: NRS, numeric rating scale.
See this image and copyright information in PMC

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