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The Effect of Skin Pressure on Needle Entry Point Accuracy During Fluoroscopically Guided Lumbar Transforaminal Epidural Injections: A Randomized Clinical Trial

Authors
 Yun, Soon Young MD  ;  Yoon, Duck Mi  ;  Yoon, Kyung Bong  ;  Moon, Ji Ae  ;  Kim, Shin Hyung 
Citation
 AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION, Vol.96(2) : 14-19, 2017 
Journal Title
 AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION 
ISSN
 0894-9115 
Issue Date
2017
MeSH
Adrenal Cortex Hormones/administration & dosage* ; Adult ; Aged ; Body Mass Index ; Female ; Fluoroscopy* ; Humans ; Injections, Epidural/methods* ; Low Back Pain/diagnostic imaging ; Low Back Pain/drug therapy ; Lumbar Vertebrae ; Male ; Middle Aged ; Needles* ; Pressure* ; Prospective Studies ; Skin*
Keywords
Needle Entry Point Accuracy ; Radiation Exposure ; Technical Performance ; Transforaminal Epidural Injection
Abstract
OBJECTIVE: The aim of this study was to investigate the effect of skin pressure on needle entry point accuracy during fluoroscopically guided lumbar transforaminal epidural injection. DESIGN: This study is a prospective randomized clinical trial; 64 patients with a body mass index of 25 kg/m or greater were enrolled. For patients in the pressing group, the operator marked the needle entry point on the patient's back while pressing the patient's skin with the tip of an indicator. For patients in the nonpressing group, the tip of the indicator was gently positioned on the patient's skin. The data related to technical performance and radiation exposure during the procedure were compared. RESULTS: Sixty patients (nonpressing group, n = 30; pressing group, n = 30) were analyzed. There were more attempts to reposition the needle (n) and increased procedure time (in seconds) in the pressing group (median, 5 vs. 4 [P = 0.019]; 400.0 vs. 358.5 [P = 0.033]). The fluoroscopy time (in seconds) and the kerma-area product (in cGy cm) were also significantly longer and greater in the pressing group, respectively (median, 63.5 vs. 50.5 [P = 0.038]; 416.3 vs. 318.6 [P = 0.014]). CONCLUSIONS: This study shows that practitioners should not press the skin with a radiopaque indicator when determining the needle entry point by fluoroscopy during lumbar transforaminal epidural injection.
Full Text
http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00002060-201702000-00009&LSLINK=80&D=ovft
DOI
10.1097/PHM.0000000000000663
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Shin Hyung(김신형) ORCID logo https://orcid.org/0000-0003-4058-7697
Yoon, Kyoung Bong(윤경봉) ORCID logo https://orcid.org/0000-0002-4167-1375
Yoon, Duck Mi(윤덕미)
Yun, Soon Young(윤순영)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/154096
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