PT - JOURNAL ARTICLE AU - Manfred Greher AU - Bernhard Moriggl AU - Philip W.H. Peng AU - Cristina E. Minella AU - Michela Zacchino AU - Urs Eichenberger TI - Ultrasound-Guided Approach for L5 Dorsal Ramus Block and Fluoroscopic Evaluation in Unpreselected Cadavers AID - 10.1097/AAP.0000000000000314 DP - 2015 Nov 01 TA - Regional Anesthesia & Pain Medicine PG - 713--717 VI - 40 IP - 6 4099 - http://rapm.bmj.com/content/40/6/713.short 4100 - http://rapm.bmj.com/content/40/6/713.full SO - Reg Anesth Pain Med2015 Nov 01; 40 AB - Background and Objectives Medial branch blocks are frequently performed to diagnose lumbar facet-joint–mediated pain. Ultrasound guidance can increase practicability and eliminate exposure to ionizing radiation when compared with fluoroscopy. However, ultrasound-guided L5 dorsal ramus block, which, together with L4 medial branch block is necessary to anesthetize the most commonly affected facet joint L5/S1, has not been described so far. The objective of this study was to develop a technique and to evaluate its accuracy with standard fluoroscopy in unpreselected cadavers.Methods Twenty ultrasound-guided L5 dorsal ramus block approaches were performed with a new oblique out-of-plane technique in a rotated cross-axis view bilaterally in 10 cadavers. After checking the needle position in a second perpendicular sonographic plane, the final needle position was confirmed with conventional fluoroscopy by an independent observer.Results All cadavers had significant degenerations of the lumbar spine, and 5 of them had moderate to severe spondylolisthesis. Skin-to-target distances were 42 ±7 mm. Sixteen L5 dorsal ramus block attempts were located at the exact radiological target, 1 was slightly too lateral, and 3 were slightly too caudal (3–10 mm away). The overall success rate in unpreselected cadavers reached 80% (95% confidence interval, 56%–94%) and in the subgroup of corpses without spondylolisthesis 100% (95% confidence interval, 69%–100%).Conclusions This is the first study to show that ultrasound-guided L5 dorsal ramus block is accurate and feasible in the absence of significant spondylolisthesis when performed with an oblique out-of-plane technique.