A Randomized Comparison Between Ultrasound- and Fluoroscopy-Guided Sacral Lateral Branch Blocks

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.