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The Role of Power Doppler Ultrasonography in Caudal Epidural Injection

Background and Objectives: Although the ultrasound-guided technique is used in caudal epidural injections, severe complications can happen if ultrasound cannot identify the occurrence of intravascular injection. To determine intraepidural and intravascular injection during caudal epidural injections...

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Autores principales: Tsai, Yueh-Hsun, Huang, Guo-Shu, Tang, Chi-Tun, Yang, Fu-Chi, Hsu, Yi-Chih
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9144919/
https://www.ncbi.nlm.nih.gov/pubmed/35629992
http://dx.doi.org/10.3390/medicina58050575
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author Tsai, Yueh-Hsun
Huang, Guo-Shu
Tang, Chi-Tun
Yang, Fu-Chi
Hsu, Yi-Chih
author_facet Tsai, Yueh-Hsun
Huang, Guo-Shu
Tang, Chi-Tun
Yang, Fu-Chi
Hsu, Yi-Chih
author_sort Tsai, Yueh-Hsun
collection PubMed
description Background and Objectives: Although the ultrasound-guided technique is used in caudal epidural injections, severe complications can happen if ultrasound cannot identify the occurrence of intravascular injection. To determine intraepidural and intravascular injection during caudal epidural injections, we used power Doppler ultrasonography (PDU) when injecting medications into the epidural space. Materials and Methods: This is a retrospective study that enrolled a total of 277 patients with refractory low back pain or degenerative disc from January 2019 to December 2019. The injectate flow of caudal epidural injections was examined with the assistance of PDU and confirmed by fluoroscopy. Four flow patterns were identified by PDU in our study: the “Earthworm sign,” the “Patch sign,” the ”Tubular sign” and the “Absent flow sign.” The accuracy of PDU in identifying intraepidural and intravascular injections was determined by fluoroscopy images recorded during each injection. Results: We evaluated 277 patients (mean age, 68.6 ± 13.2 years; 106 men). The “Patch sign” showed a sensitivity of 88.76% and a specificity of 80% in predicting epidural injection without intravascular injection. The “Earthworm sign” demonstrated a sensitivity of 70% and a specificity of 100% in detecting intravascular injection. The “Tubular sign” showed a specificity of 100% and a sensitivity of 9.4% in predicting successful epidural injection. The absence of a flow signal showed a sensitivity of 1.87% and a specificity of 90% in predicting successful epidural injection. Conclusions: Ultrasound-guided caudal epidural injection can accurately determine intraepidural and intravascular injections with the assistance of PDU and is thus a good alternative technique to fluoroscopy-guided caudal epidural injection.
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spelling pubmed-91449192022-05-29 The Role of Power Doppler Ultrasonography in Caudal Epidural Injection Tsai, Yueh-Hsun Huang, Guo-Shu Tang, Chi-Tun Yang, Fu-Chi Hsu, Yi-Chih Medicina (Kaunas) Article Background and Objectives: Although the ultrasound-guided technique is used in caudal epidural injections, severe complications can happen if ultrasound cannot identify the occurrence of intravascular injection. To determine intraepidural and intravascular injection during caudal epidural injections, we used power Doppler ultrasonography (PDU) when injecting medications into the epidural space. Materials and Methods: This is a retrospective study that enrolled a total of 277 patients with refractory low back pain or degenerative disc from January 2019 to December 2019. The injectate flow of caudal epidural injections was examined with the assistance of PDU and confirmed by fluoroscopy. Four flow patterns were identified by PDU in our study: the “Earthworm sign,” the “Patch sign,” the ”Tubular sign” and the “Absent flow sign.” The accuracy of PDU in identifying intraepidural and intravascular injections was determined by fluoroscopy images recorded during each injection. Results: We evaluated 277 patients (mean age, 68.6 ± 13.2 years; 106 men). The “Patch sign” showed a sensitivity of 88.76% and a specificity of 80% in predicting epidural injection without intravascular injection. The “Earthworm sign” demonstrated a sensitivity of 70% and a specificity of 100% in detecting intravascular injection. The “Tubular sign” showed a specificity of 100% and a sensitivity of 9.4% in predicting successful epidural injection. The absence of a flow signal showed a sensitivity of 1.87% and a specificity of 90% in predicting successful epidural injection. Conclusions: Ultrasound-guided caudal epidural injection can accurately determine intraepidural and intravascular injections with the assistance of PDU and is thus a good alternative technique to fluoroscopy-guided caudal epidural injection. MDPI 2022-04-22 /pmc/articles/PMC9144919/ /pubmed/35629992 http://dx.doi.org/10.3390/medicina58050575 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Tsai, Yueh-Hsun
Huang, Guo-Shu
Tang, Chi-Tun
Yang, Fu-Chi
Hsu, Yi-Chih
The Role of Power Doppler Ultrasonography in Caudal Epidural Injection
title The Role of Power Doppler Ultrasonography in Caudal Epidural Injection
title_full The Role of Power Doppler Ultrasonography in Caudal Epidural Injection
title_fullStr The Role of Power Doppler Ultrasonography in Caudal Epidural Injection
title_full_unstemmed The Role of Power Doppler Ultrasonography in Caudal Epidural Injection
title_short The Role of Power Doppler Ultrasonography in Caudal Epidural Injection
title_sort role of power doppler ultrasonography in caudal epidural injection
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9144919/
https://www.ncbi.nlm.nih.gov/pubmed/35629992
http://dx.doi.org/10.3390/medicina58050575
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