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Related Concept Videos

Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
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Related Experiment Video

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A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations
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Optimal needle entry angle for cervical transforaminal epidural injections.

Boqing Chen, Leia Rispoli, Todd P Stitik

  • 1Department of Physical Medicine and Rehabilitation, Rutgers - New Jersey Medical School, Newark, NJ.

Pain Physician
|March 25, 2014
PubMed
Summary

This study determined the optimal needle entry angle for cervical transforaminal epidural steroid injections (CTFESI) and cervical selective nerve root blocks (CSNRB). The ideal angle, averaging slightly less than 50 degrees, was identified using CT scans for improved procedural accuracy.

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Area of Science:

  • Pain Management
  • Interventional Radiology
  • Spinal Procedures

Background:

  • Cervical epidural steroid injections (CESI) are used for radicular pain due to disc herniation or stenosis.
  • Interlaminar and transforaminal approaches exist, with interlaminar being more common.
  • Cervical selective nerve root block (CSNRB) uses a similar approach to CTFESI but is primarily diagnostic.

Purpose of the Study:

  • To determine the optimal needle entry angle for CTFESI and CSNRB.
  • To utilize fluoroscopically guided anterior oblique approach.
  • To measure optimal angles using cervical spine CT scans.

Main Methods:

  • Retrospective case series analysis of 190 patients (21-78 years old).
  • Analysis of post-discography CT scans from March 2009 to July 2012.
  • Measurement of needle entry angles bilaterally at C3-4, C4-5, C5-6, C6-7, and C7-T1 levels.

Main Results:

  • The average optimal needle entry angle was approximately 48-49 degrees across vertebral levels.
  • The 95% confidence interval for the optimal angle was 39.84 to 57.56 degrees.
  • Optimal entry angles ranged from 33 to 68 degrees.

Conclusions:

  • This is the first study to investigate optimal needle entry angles for CTFESI/CSNRB.
  • An average angle of slightly less than 50 degrees is suggested for the anterior oblique approach.
  • Further clinical research is warranted to confirm the utility of these findings.