Comparison of the caudal and lumbar approaches to the epidural space.
OBJECTIVES: To investigate the accuracy of placement of epidural injections using the lumbar and caudal approaches. To identify which factors, if any, predicted successful placement. METHODS: 200 consecutive patients referred to a pain clinic for an epidural injection of steroid were randomly alloca...
| Main Authors: | , , , |
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| Format: | Journal article |
| Language: | English |
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2000
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| _version_ | 1797090395317862400 |
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| author | Price, C Rogers, P Prosser, A Arden, N |
| author_facet | Price, C Rogers, P Prosser, A Arden, N |
| author_sort | Price, C |
| collection | OXFORD |
| description | OBJECTIVES: To investigate the accuracy of placement of epidural injections using the lumbar and caudal approaches. To identify which factors, if any, predicted successful placement. METHODS: 200 consecutive patients referred to a pain clinic for an epidural injection of steroid were randomly allocated to one of two groups. Group L had a lumbar approach to the epidural space and group C a caudal approach to the epidural space. Both groups then had epidurography performed using Omnipaque and an image intensifier to determine the position of the needle. RESULTS: Body mass index (BMI), grade of operator, and route of injection were predictors of a successful placement. 93% of lumbar and 64% of caudal epidural injections were correctly placed (p< 0.001). 97% of lumbar and 85% of caudal epidural injections clinically thought to be correctly placed were confirmed radiographically. For epidural injections where the clinical impression was "maybe", 91% of lumbar injections, but only 45% of caudal injections were correctly placed. Obesity was associated with a reduced chance of successful placement (odds ratio (OR) 0.34 (95% confidence interval (CI) 0.17 to 0.72) BMI >30 v BMI <30). A more senior grade of operator was associated with a reduced chance of successful placement (OR 0.16 (95% CI 0.03 to 0.89) consultant v other). However, small numbers may have accounted for the latter result. CONCLUSIONS: The weight of the patient and intended approach need to be considered when deciding the method used to enter the epidural space. In the non-obese patient, lumbar epidural injections can be accurately placed without x ray screening, but caudal epidural injections, to be placed accurately, require x ray screening no matter what the weight of the patient. |
| first_indexed | 2024-03-07T03:17:57Z |
| format | Journal article |
| id | oxford-uuid:b673b414-c8bc-47e6-b48e-4a1df9b8dcba |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T03:17:57Z |
| publishDate | 2000 |
| record_format | dspace |
| spelling | oxford-uuid:b673b414-c8bc-47e6-b48e-4a1df9b8dcba2022-03-27T04:41:07ZComparison of the caudal and lumbar approaches to the epidural space.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:b673b414-c8bc-47e6-b48e-4a1df9b8dcbaEnglishSymplectic Elements at Oxford2000Price, CRogers, PProsser, AArden, NOBJECTIVES: To investigate the accuracy of placement of epidural injections using the lumbar and caudal approaches. To identify which factors, if any, predicted successful placement. METHODS: 200 consecutive patients referred to a pain clinic for an epidural injection of steroid were randomly allocated to one of two groups. Group L had a lumbar approach to the epidural space and group C a caudal approach to the epidural space. Both groups then had epidurography performed using Omnipaque and an image intensifier to determine the position of the needle. RESULTS: Body mass index (BMI), grade of operator, and route of injection were predictors of a successful placement. 93% of lumbar and 64% of caudal epidural injections were correctly placed (p< 0.001). 97% of lumbar and 85% of caudal epidural injections clinically thought to be correctly placed were confirmed radiographically. For epidural injections where the clinical impression was "maybe", 91% of lumbar injections, but only 45% of caudal injections were correctly placed. Obesity was associated with a reduced chance of successful placement (odds ratio (OR) 0.34 (95% confidence interval (CI) 0.17 to 0.72) BMI >30 v BMI <30). A more senior grade of operator was associated with a reduced chance of successful placement (OR 0.16 (95% CI 0.03 to 0.89) consultant v other). However, small numbers may have accounted for the latter result. CONCLUSIONS: The weight of the patient and intended approach need to be considered when deciding the method used to enter the epidural space. In the non-obese patient, lumbar epidural injections can be accurately placed without x ray screening, but caudal epidural injections, to be placed accurately, require x ray screening no matter what the weight of the patient. |
| spellingShingle | Price, C Rogers, P Prosser, A Arden, N Comparison of the caudal and lumbar approaches to the epidural space. |
| title | Comparison of the caudal and lumbar approaches to the epidural space. |
| title_full | Comparison of the caudal and lumbar approaches to the epidural space. |
| title_fullStr | Comparison of the caudal and lumbar approaches to the epidural space. |
| title_full_unstemmed | Comparison of the caudal and lumbar approaches to the epidural space. |
| title_short | Comparison of the caudal and lumbar approaches to the epidural space. |
| title_sort | comparison of the caudal and lumbar approaches to the epidural space |
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