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Kibeom Park 1 Article
Digital subtraction angiography vs. real-time fluoroscopy for detection of intravascular injection during transforaminal epidural block
Kibeom Park, Saeyoung Kim
Yeungnam Univ J Med. 2019;36(2):109-114.   Published online January 24, 2019
DOI: https://doi.org/10.12701/yujm.2019.00122
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  • 5 Crossref
AbstractAbstract PDF
Background
Transforaminal epidural block (TFEB) is an effective treatment option for radicular pain. To reduce complications from intravascular injection during TFEB, use of imaging modalities such as real-time fluoroscopy (RTF) or digital subtraction angiography (DSA) has been recommended. In this study, we investigated whether DSA improved the detection of intravascular injection during TFEB at the whole spine level compared to RTF.
Methods
We prospectively examined 316 patients who underwent TFEB. After confirmation of final needle position using biplanar fluoroscopy, 2 mL of nonionic contrast medium was injected at a rate of 0.5 mL/s under RTF; 30 s later, 2 mL of nonionic contrast medium was injected at a rate of 0.5 mL/s under DSA.
Results
Thirty-six intravascular injections were detected for an overall rate of 11.4% using RTF, with 45 detected for a rate of 14.2% using DSA. The detection rate using DSA was statistically different from that using RTF (p=0.004). DSA detected a significantly higher proportion of intravascular injections at the cervical level than at the thoracic (p=0.009) and lumbar (p=0.011) levels.
Conclusion
During TFEB at the whole spine level, DSA was better than RTF for the detection of intravascular injection. Special attention is advised for cervical TFEB, because of a significantly higher intravascular injection rate at this level than at other levels.

Citations

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  • Safety of local anesthetics in cervical nerve root injections: a narrative review
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    Journal of Pain Research.2021; Volume 14: 2139.     CrossRef

JYMS : Journal of Yeungnam Medical Science