title: Usefulness of a pre-procedure ultrasound scanning of the lumbar spine before epidural injection in patients with a presumed difficult puncture: A randomized controlled trial.
abstract: Ultrasound (US) is widely used in rheumatology to study and guide injection of peripheral joints. It can also provide useful information about the anatomy of the lumbar spine. Studies have shown that US examination of the spine was a useful tool to help perform epidural anaesthesia. The purpose of the study was to determine if the selection of the optimum puncture level by US may facilitate epidural steroid injection in case of presumed difficult puncture (BMI>30 kg/m(2), age>60 years or lumbar scoliosis).
  
  
  METHODS
  We performed a prospective randomized controlled study. Eighty patients were randomized in two groups: US group (n=40) which underwent a pre-procedure spinal US to determine the optimal lumbar level for injection or control group (n=40) for which the level of injection was determined by palpation. Primary endpoint was the pain during the procedure assessed using the Visual Analogue Scale (VAS).
  
  
  RESULTS
  We found a positive correlation between depth of the epidural space and BMI (P<0.001) and a negative correlation between size of the interspinous spaces and age (P<0.01). Visibility of the epidural space was not altered by obesity or age. We observed a trend toward a reduction in pain intensity during the procedure in the US group compared to the control group with a mean difference at -0.94 [-1.90; 0.02] but the difference was not significant (P=0.054).
  
  
  CONCLUSIONS
  US of the lumbar spine was feasible in patients with lumbar conditions even in obese and old ones and allowed the visualization of the epidural space. However, pre-procedure US examination did not reduce pain during the procedure.
authors.affiliation: Rheumatology unit, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France. Electronic address: christelle.darrieutort@chu-nantes.fr.
authors.forename: Christelle
authors.initials: C
authors.lastname: Darrieutort-Laffite
authors.affiliation: Rheumatology unit, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Bart
authors.affiliation: Biometrics Platform, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Planche
authors.affiliation: Rheumatology unit, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
authors.forename: Joelle
authors.initials: J
authors.lastname: Glemarec
authors.affiliation: Rheumatology unit, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Maugars
authors.affiliation: Rheumatology unit, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Le Goff
mesh_terms: D000767:Anesthesia, Epidural / Q000379:methods*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D007268:Injections, Epidural; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008161:Lumbosacral Region / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D012585:Sciatica / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016037:Single-Blind Method; D013129:Spinal Puncture; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone
keywords: Difficult puncture; Epidural space; Sciatica; Steroid injection; Ultrasound