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Related Concept Videos

Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
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A Randomized Comparison Between Ultrasound- and Fluoroscopy-Guided Sacral Lateral Branch Blocks.

Roderick J Finlayson1, John-Paul B Etheridge, Maria Francisca Elgueta

  • 1From the *Department of Anesthesiology, Alan Edwards Pain Management Unit, McGill University Health Centre, Montreal, Quebec, Canada; †Kelowna General Hospital, Kelowna, British Columbia, Canada and University of British Columbia, Kelowna, British Columbia, Canada; and ‡Department of Anesthesiology, Chulalongkorn University, Bangkok, Thailand.

Regional Anesthesia and Pain Medicine
|February 9, 2017
PubMed
Summary

Ultrasound-guided sacral lateral branch (SLB) blocks offer a faster procedure with fewer needle passes and reduced vascular breach risk compared to fluoroscopy. Both methods provide similar pain relief for chronic low back pain.

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Area of Science:

  • Pain Management
  • Interventional Radiology
  • Musculoskeletal Medicine

Background:

  • Chronic low back pain often necessitates interventions targeting the sacral region.
  • Sacral lateral branch (SLB) blocks are utilized for pain management in specific patient populations.
  • Ultrasound (US) and fluoroscopy are imaging modalities used for guiding these procedures.

Purpose of the Study:

  • To compare the performance time, needle passes, and vascular breach incidence between ultrasound-guided and fluoroscopy-guided SLB blocks.
  • To evaluate the efficacy of SLB blocks guided by US versus fluoroscopy in managing chronic low back pain.
  • To assess the impact of operator experience on procedural outcomes.

Main Methods:

  • A randomized trial involving 40 patients with chronic low back pain requiring unilateral SLB blocks.
  • Patients were randomized to either US-guided or fluoroscopy-guided SLB block procedures.
  • Performance time, needle passes, vascular breach, and analgesic effects were recorded and compared between groups.

Main Results:

  • Ultrasound guidance resulted in significantly shorter performance times (267.5s vs 628.7s) and fewer needle passes compared to fluoroscopy.
  • The incidence of vascular breach was lower with US guidance (0 vs 10 occurrences).
  • Both US and fluoroscopy guidance demonstrated similar analgesic block effects and proportions of patients achieving complete analgesia.

Conclusions:

  • Ultrasound-guided SLB blocks are associated with reduced procedural time, fewer needle manipulations, and a lower risk of vascular complications.
  • The analgesic efficacy of SLB blocks is comparable between ultrasound and fluoroscopy guidance.
  • Operator experience significantly influences performance time with ultrasound guidance.