title: Needle Tip Position and Bevel Direction Have No Effect in the Fluoroscopic Epidural Spreading Pattern in Caudal Epidural Injections: A Randomized Trial.
abstract: Background. Caudal epidural steroid injections (CESIs) are an effective treatment for pain. If the injection spreads in a specific pattern depending on the needle position or bevel direction, it would be possible to inject the agent into a specific and desired area. Objectives. We conducted a prospective randomized trial to determine if the needle position and bevel direction have any effect on the epidural spreading pattern in CESI. Methods. Demographic data of the patient were collected. During CESI, the needle position (middle or lateral) and direction (ventral or dorsal) were randomly allocated. Following fluoroscope-guided injection of 4 mL contrast media and 10 mL of injectates, the epidural spreading patterns (ventral or dorsal, bilateral or lateral) were imaged. Results. In the 210 CESIs performed, the needle tip position and bevel direction did not influence the epidural spreading patterns at L4-5 and L5-S1 disc levels. A history of Lumbar spine surgery was associated with a significantly limited spread to each disc level. A midline needle tip position was more effective than the lateral position in spreading to the distant disc levels. Conclusions. Neither the needle tip position nor the bevel direction affected the epidural drug spreading pattern during CESI.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Neungdong-ro 120-1, Kwangjin-gu, Seoul 05030, Republic of Korea.
authors.forename: Won Kyoung
authors.initials: WK
authors.lastname: Kwon
authors.affiliation: Department of Anesthesiology and Pain Medicine, Wondang OK Pain Clinic, 783 Hoguk-ro, Deogyang-gu, Goyang-si, Gyeonggi-do 10461, Republic of Korea.
authors.forename: Ah Na
authors.initials: AN
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Neungdong-ro 120-1, Kwangjin-gu, Seoul 05030, Republic of Korea.
authors.forename: Pil Moo
authors.initials: PM
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Neungdong-ro 120-1, Kwangjin-gu, Seoul 05030, Republic of Korea.
authors.forename: Cheol Hwan
authors.initials: CH
authors.lastname: Park
authors.affiliation: Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Neungdong-ro 120-1, Kwangjin-gu, Seoul 05030, Republic of Korea.
authors.forename: Jae Hun
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000368:Aged; D003287:Contrast Media; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007268:Injections, Epidural / Q000379:methods; D017116:Low Back Pain / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009339:Needles / Q000009:adverse effects*; D011446:Prospective Studies; D013256:Steroids / Q000008:administration & dosage*
chemical_list: D003287:Contrast Media; D013256:Steroids