Comparison of Multilevel with Single Level Injection during Lumbar Sympathetic Ganglion Block: Efficacy of Sympatholysis and Incidence of Psoas Muscle Injection
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Background:We prospectively evaluated the incidence and possible factors causing intramuscular injection during lumbar sympathetic ganglion block and compared the multiple needle technique to the single technique to obtain a profound and complete block effect. Methods:Among 83 patients, 58 patients (group A, n = 27, multiple needle technique and group B, n = 31, single needle technique) were reevaluated for the changes of skin temperature (Ts) and mean segment of longitudinal contrast spread. After injecting the contrast agent, the incidence of psoas muscle injection and the change of Ts was compared between two groups. Results:The incidence of psoas muscle injection was 21.3% (46/216) and it was associated with the level of injection (L2) significantly (c2 = 14.773, P = 0.001). DTpost (postblock temperature difference between ipsilateral and contralateral great toe, 4.6 ± 2.8oC, 1.8 ± 1.6oC, P ＜ 0.001 for group A and B) and DTnet (DTpost − DTpre, 3.9 ± 2.7oC, 1.5 ± 1.5oC, P ＜ 0.001 for group A and B) was significantly higher in group A. The mean segment of longitudinal contrast spread was 8.1 ± 0.9 for group A and 3.2 ± 1.6 for group B (P ＜ 0.001). Conclusions:The LSGB at the L2 level showed the lowest incidence of psoas muscle injection of contrast. Multiple needle approach showed more significant increase of DTnet and DTpost. (Korean J Pain 2010; 23: 131-136)
Abstract
Background:We prospectively evaluated the incidence and possible factors causing intramuscular injection during lumbar sympathetic ganglion block and compared the multiple needle technique to the single technique to obtain a profound and complete block effect. Methods:Among 83 patients, 58 patients (group A, n = 27, multiple needle technique and group B, n = 31, single needle technique) were reevaluated for the changes of skin temperature (Ts) and mean segment of longitudinal contrast spread. After injecting the contrast agent, the incidence of psoas muscle injection and the change of Ts was compared between two groups. Results:The incidence of psoas muscle injection was 21.3% (46/216) and it was associated with the level of injection (L2) significantly (c2 = 14.773, P = 0.001). DTpost (postblock temperature difference between ipsilateral and contralateral great toe, 4.6 ± 2.8oC, 1.8 ± 1.6oC, P ＜ 0.001 for group A and B) and DTnet (DTpost − DTpre, 3.9 ± 2.7oC, 1.5 ± 1.5oC, P ＜ 0.001 for group A and B) was significantly higher in group A. The mean segment of longitudinal contrast spread was 8.1 ± 0.9 for group A and 3.2 ± 1.6 for group B (P ＜ 0.001). Conclusions:The LSGB at the L2 level showed the lowest incidence of psoas muscle injection of contrast. Multiple needle approach showed more significant increase of DTnet and DTpost. (Korean J Pain 2010; 23: 131-136)
참고문헌 (14)
- de Oliveira R, "The effects of early or late neurolytic sympathetic plexus block on the management of abdominal or pelvic cancer pain", Pain, 110, pp.400~408 (2004)
- Day M, "Sympathetic blocks: the evidence", Pain Pract, 8, pp.98~109 (2008)
- Kline MT, "Radiofrequency techniques in clinical practice. In: Interventional pain management. 2nd ed", pp.243~293 (2001), W.B. Saunders
- Datta S, "Paradiscal extraforaminal technique for lumbar sympathetic block: report of a proposed new technique utilizing a cadavar study", Pain Physician, 7, pp.53~57 (2004)
- Rocco AG, "Anatomy of the lumbar sympathetic chain", Reg Anesth, 20, pp.13~19 (1995)
- Murata Y, "Variations in the number and position of human lumbar sympathetic ganglia and rami communicantes", Clin Anat, 16, pp.108~113 (2003)
- Stevens RA, "The relative increase in skin temperature after stellate ganglion block is predictive of a complete sympathectomy of the hand", Reg Anesth Pain Med, 23, pp.266~270 (1998)
- Schmid MR, "Sympathetic skin response: Monitoring of CT-guided lumbar sympathetic blocks", Radiology, 241, pp.595~602 (2006)
- Sayson SC, "Incidence of genitofemoral nerve block during lumbar sympathetic block: comparison of two lumbar injection sites", Reg Anesth, 22, pp.569~574 (1997)
- Ranson CA, "An investigation into the use of MR imaging to determine the functional cross sectional area of lumbar paraspinal muscles", Eur Spine J, 15, pp.764~773 (2006)
- Werdehausen R, "Uniform distribution of skin-temperature increase after different regional anesthesia techniques of the lower extremity", Reg Anesth Pain Med, 32, pp.73~78 (2007)
- Yong-ChulKim, "Infrared Thermographic Imaging in the Assessment of Successful Block on Lumbar Sympathetic Ganglion", Yonsei Medical Journal, 44(1), pp.119~124 (2003), 연세대학교의과대학
- Stevens RA, "The relative increase in skin temperature after stellate ganglion block is predictive of a complete sympathectomy of the hand", Reg Anesth Pain Med, 23, pp.266~270 (1998)
- Nahm SG, "The cutoff rate of temperature to interpret the successful lumbar sympathetic block", The Korean Pain Society The forty nine Scientific Meeting (2009)