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Comparison of Intravascular Uptake and Technical Ease Between Anteroposterior and Oblique Views During Lumbar Medial
Ji Hee Hong1, Ji Hoon Park1, Seung Hoon Shin1
1Keimyung University DongSan Hospital Department of Anesthesiology and Pain Medicine, Dalseo-gu, Daegu, Korea.
Background:
Inadvertent intravascular injection of local anesthetics can lead to false-negative results following lumbar medial branch block (MBB) performed to diagnose facet joint origin pain. A previous study demonstrated that the type of approach method could affect the incidence of intravascular injections and technical ease of the procedure.
Objectives:
The primary objective of our study was to compare the incidence of inadvertent intravascular injection and technical ease of the MBB between anteroposterior (AP) and oblique (OB) views.
Study Design:
Prospective randomized trial.
Setting:
An interventional pain management practice in South Korea.
Methods:
The incidence of intravascular uptake of contrast medium was compared using AP and OB fluoroscopic views during lumbar MBB. Injection time, radiation dose, and patient discomfort during lumbar MBB were also compared. Risk factors associated with a longer procedure time and a higher radiation dose were analyzed.
Results:
The incidence of intravascular injection was 22.5% (23/102) in the AP group and 17.6% (18/102) in the OB group (P = 0.382). A significantly longer injection time and a higher dose of radiation were required to complete 3 levels of MBB in the OB group than in the AP group (45.9 seconds vs 61.9 seconds, P = 0.001; 27.4 centigray [cGy]/cm2 vs 42.2 cGy/cm2, I = 0.004). The OB approach and left side injection were the risk factors associated with a longer total procedure time (odds ratio [OR] = 6.64, 95% CI, 1.99-22.17, P = 0.002; OR = 0.20, 95% CI, 0.06-0.67, P = 0.009, OB and AP, respectively).
Limitations:
The physician performing the MBB could recognize the AP or OB fluoroscopic view during procedure.
Conclusion:
The overall incidence rate of intravascular injection during lumbar MBB showed nearly 20% in both approach methods groups. The OB approach and left side MBBs were associated with a longer total procedure time and a higher radiation dose.
Insights
The anteroposterior (AP) view for lumbar medial branch blocks (MBB) showed a similar intravascular injection rate to the oblique (OB) view but with a shorter procedure time and lower radiation dose. The OB approach and left-sided injections were linked to longer procedures and increased radiation exposure.
Area of Science:
- Pain Management
- Interventional Radiology
- Anesthesiology
Background:
- Inadvertent intravascular injection during lumbar medial branch block (MBB) can compromise diagnostic accuracy for facet joint pain.
- Previous research suggests approach methods influence intravascular injection rates and procedural ease.
Purpose of the Study:
- To compare the incidence of inadvertent intravascular injection and technical ease of lumbar MBB between anteroposterior (AP) and oblique (OB) fluoroscopic views.
Main Methods:
- A prospective randomized trial was conducted in an interventional pain management practice.
- The study compared intravascular contrast uptake, injection time, radiation dose, and patient discomfort between AP and OB views during lumbar MBB.
- Risk factors for prolonged procedure time and higher radiation dose were analyzed.
Main Results:
- The incidence of intravascular injection was comparable between groups: 22.5% (AP) and 17.6% (OB) (P = 0.382).
- The OB group required significantly longer injection times (61.9s vs 45.9s, P = 0.001) and higher radiation doses (42.2 cGy/cm² vs 27.4 cGy/cm², P = 0.004) for three levels.
- Oblique approach and left-sided injections were risk factors for longer procedure times (OR = 6.64, P = 0.002; OR = 0.20, P = 0.009, respectively).
Conclusions:
- Lumbar MBB using either AP or OB views resulted in a nearly 20% overall incidence of intravascular injection.
- The OB approach was associated with increased procedure time and radiation dose compared to the AP approach.
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