title: The Effect of Skin Pressure on Needle Entry Point Accuracy During Fluoroscopically Guided Lumbar Transforaminal Epidural Injections: A Randomized Clinical Trial.
abstract: OBJECTIVE
  The aim of this study was to investigate the effect of skin pressure on needle entry point accuracy during fluoroscopically guided lumbar transforaminal epidural injection.
  
  
  METHODS
  This study is a prospective randomized clinical trial; 64 patients with a body mass index of 25 kg/m or greater were enrolled. For patients in the pressing group, the operator marked the needle entry point on the patient's back while pressing the patient's skin with the tip of an indicator. For patients in the nonpressing group, the tip of the indicator was gently positioned on the patient's skin. The data related to technical performance and radiation exposure during the procedure were compared.
  
  
  RESULTS
  Sixty patients (nonpressing group, n = 30; pressing group, n = 30) were analyzed. There were more attempts to reposition the needle (n) and increased procedure time (in seconds) in the pressing group (median, 5 vs. 4 [P = 0.019]; 400.0 vs. 358.5 [P = 0.033]). The fluoroscopy time (in seconds) and the kerma-area product (in cGy cm) were also significantly longer and greater in the pressing group, respectively (median, 63.5 vs. 50.5 [P = 0.038]; 416.3 vs. 318.6 [P = 0.014]).
  
  
  CONCLUSIONS
  This study shows that practitioners should not press the skin with a radiopaque indicator when determining the needle entry point by fluoroscopy during lumbar transforaminal epidural injection.
authors.affiliation: From the Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Soon Young
authors.initials: SY
authors.lastname: Yun
authors.forename: Duck Mi
authors.initials: DM
authors.lastname: Yoon
authors.forename: Kyung Bong
authors.initials: KB
authors.lastname: Yoon
authors.forename: Ji Ae
authors.initials: JA
authors.lastname: Moon
authors.forename: Shin Hyung
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007268:Injections, Epidural / Q000379:methods*; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000188:drug therapy; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D009339:Needles; D011312:Pressure; D011446:Prospective Studies; D012867:Skin
chemical_list: D000305:Adrenal Cortex Hormones