Retrospective comparison of ultrasound and fluoroscopic image guidance for intercostal steroid injections

Steroid injection around the intercostal nerves is one of the treatment options for intercostal neuralgia. The technique may be performed blindly, under fluoroscopic guidance (FSG) or with the use of ultrasound guidance (USG). This study is a retrospective comparison of image guidance for intercostal steroid injections.

After Institutional Review Board approval, a retrospective review of all patient charts who received intercostal steroid injections from 2005 to 2009 was performed. A total of 39 blocks were performed in that period. Of that 12 were USG blocks and 27 FSG blocks. The preprocedure visual analog scale (VAS) and postprocedure VAS and the duration of pain relief were compared between the 2 techniques. A Mann-Whitney test and Kruskal-Wallis test were performed looking for differences between the techniques.

The median change in the VAS for FSG and USG were -5.000 and -4.000, respectively, and duration of pain relief with a median difference of 2 weeks (95% confidence interval of -4, 7). There were 2 occasions of intravascular spread noticed with the FSG although this should not affect the study result as the needle was repositioned and steroid injected only after contrast dye confirmation.

With similar change in VAS scores and duration of pain relief between the 2 guidance methods based on this retrospective study, both image guidance techniques may offer similar pain relief.