Comparison of the contralateral oblique view with the lateral view for mid-thoracic epidural access under fluoroscopic guidance: a randomized controlled trial.
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引用次数: 0
Abstract
Background: The fluoroscopic-guided epidural access is occasionally challenging; therefore, the contralateral oblique (CLO) view has emerged as an alternative approach. The CLO view appears to be optimal for mid-thoracic epidural access; however, evidence on its utility is lacking. Therefore, we aimed to evaluate the clinical usefulness of the CLO view at 60°±5° compared with the lateral (LAT) view using fluoroscopic-guided mid-thoracic epidural access.
Methods: Patients were randomly allocated to undergo mid-thoracic epidural access under the fluoroscopic LAT view (LAT group) or CLO view (CLO group). The primary outcome was the first-pass success rate of mid-thoracic epidural access. The secondary outcomes were procedural pain intensity, patient satisfaction, needling time, number of needle passes, and radiation dose.
Results: Seventy-nine patients were included. The first-pass success rate was significantly higher in the CLO group than in the LAT group (68.3% vs 34.2%, difference: 34.1%; 95% CI 13.3 to 54.8; p=0.003). Procedural pain intensity was significantly lower in the CLO group than in the LAT group. Patient satisfaction was significantly greater in the CLO group than in the LAT group. The needling time and the number of needle passes were significantly lower in the CLO group than in the LAT group. Radiation dose in the CLO group was significantly reduced compared with that in the LAT group.
Conclusions: The fluoroscopic CLO view at 60°±5° increased the success rate and patient satisfaction and reduced the procedural time and patient discomfort compared with the LAT view when performing mid-thoracic epidural access. Therefore, the CLO view at 60°±5° can be considered for mid-thoracic epidural access under fluoroscopic guidance.
背景：荧光透视引导下的硬膜外通路有时具有挑战性；因此，对侧斜视（CLO）已成为一种替代方法。CLO 视图似乎是中胸硬膜外通路的最佳视图，但其实用性尚缺乏证据。因此，我们旨在评估在透视引导下进行中胸腔硬膜外通路时，60°±5°的CLO视图与侧视图（LAT）相比的临床实用性：随机分配患者在透视 LAT 视图（LAT 组）或 CLO 视图（CLO 组）下进行中胸硬膜外通路手术。主要结果是中胸硬膜外通路的首次通路成功率。次要结果是手术疼痛强度、患者满意度、针刺时间、针刺次数和辐射剂量：结果：共纳入 79 名患者。CLO 组的首次穿刺成功率明显高于 LAT 组（68.3% vs 34.2%，差异：34.1%；95% CI 13.3 至 54.8；P=0.003）。CLO 组的手术疼痛强度明显低于 LAT 组。CLO 组患者的满意度明显高于 LAT 组。CLO 组的针刺时间和针刺次数明显低于 LAT 组。CLO组的辐射剂量明显低于LAT组：结论：与LAT视图相比，60°±5°的透视CLO视图提高了中胸硬膜外入路的成功率和患者满意度，减少了手术时间和患者不适感。因此，在透视引导下进行中胸硬膜外通路时，可以考虑使用 60°±5° 的 CLO 视图：试验注册号：KCT0004926。
期刊介绍：
The Bulletin of Canadian Petroleum Geology is a peer-reviewed scientific journal published four times a year. Founded in 1953, the BCPG aims to be the journal of record for papers dealing with all aspects of petroleum geology, broadly conceived, with a particularly (though not exclusively) Canadian focus. International submissions are encouraged, especially where a connection can be made to Canadian examples.
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