Background The fluoroscopic-guided epidural access is occasionally challenging; therefore, the contralateral oblique (CLO) view has emerged as an alternative approach. The CLO view appears to be optimal for mid-thoracic epidural access; however, evidence on its utility is lacking. Therefore, we aimed to evaluate the clinical usefulness of the CLO view at 60°±5° compared with the lateral (LAT) view using fluoroscopic-guided mid-thoracic epidural access.
Methods Patients were randomly allocated to undergo mid-thoracic epidural access under the fluoroscopic LAT view (LAT group) or CLO view (CLO group). The primary outcome was the first-pass success rate of mid-thoracic epidural access. The secondary outcomes were procedural pain intensity, patient satisfaction, needling time, number of needle passes, and radiation dose.
Results Seventy-nine patients were included. The first-pass success rate was significantly higher in the CLO group than in the LAT group (68.3% vs 34.2%, difference: 34.1%; 95% CI 13.3 to 54.8; p=0.003). Procedural pain intensity was significantly lower in the CLO group than in the LAT group. Patient satisfaction was signiﬁcantly greater in the CLO group than in the LAT group. The needling time and the number of needle passes were significantly lower in the CLO group than in the LAT group. Radiation dose in the CLO group was significantly reduced compared with that in the LAT group.
Conclusions The fluoroscopic CLO view at 60°±5° increased the success rate and patient satisfaction and reduced the procedural time and patient discomfort compared with the LAT view when performing mid-thoracic epidural access. Therefore, the CLO view at 60°±5° can be considered for mid-thoracic epidural access under fluoroscopic guidance.
Trial registration number KCT0004926.
- chronic pain
- pain management
- pain, postoperative
Data availability statement
Data are available upon reasonable request.
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D-HK and H-JK are joint first authors.
Presented at This work was presented at the 71st Annual Meeting of the Korean Pain Society in Daejeon, Korea, 22 May 2021. This work was presented in part as D-HK’s PhD thesis at the University of Ulsan College of Medicine (2021).
Contributors D-HK: conception, design and conduct of the study; analysis and interpretation of data; reporting; writing—original draft preparation. H-JK: conception, design and conduct of the study; interpretation of data; writing—review and editing of the manuscript. BJ and DL: data curation and acquisition. J-WS: planning, conception and design of the study; supervision; project administration. S-SC: planning, conception, design and conduct of the study; writing—review and editing of the manuscript; supervision; project administration. All authors critically revised the manuscript. All authors approved the final version of the manuscript. S-SC (guarantor) accepts full responsibility for the finished work and/or the conduct of the study.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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