Abstract
Background and Objectives: This study was conducted to investigate the influence of an ultrasound-guided technique using a catheter-over-needle when an intravascular injection occurs in patients undergoing a caudal block. Material and Methods: We retrospectively investigated 41 cases of an ultrasound-guided technique using an angiocatheter for caudal block. These had been performed between November 2019 through August 2020 to manage pain of lumbosacral origin. Under ultrasound guidance, after advancing the introducer needle through the sacrococcygeal ligament and then slowly withdrawing it, the outer catheter was continuously advanced into the sacral hiatus. We confirmed proper needle placement under fluoroscopic imaging, using 5 mL of contrast media. We assessed the contrast spread pattern with fluoroscopic imaging and checked it for the presence of intravascular injection. Results: In all recruited cases, the catheter-over-needle was guided successfully to the sacral hiatus and into the caudal epidural space. There was 100% accuracy under ultrasound guidance, without intravascular uptake, as confirmed by contrast media fluoroscopy. The incidence of ventral spread was 84.2% above the S1 with 5 mL of contrast. Conclusions: The technique of using a catheter-over-needle under ultrasound induced successful block without intravascular injection. Thus, this technique is a reliable option for conventional caudal block.
Highlights
The aim of this study is to evaluate the influence of an ultrasound-guided novel technique using a catheterover-needle on inadvertent intravascular injection occurrences in patients undergoing a caudal block
We retrospectively reviewed the electronic medical records, radiologic studies, anteroposterior (AP) and lateral fluoroscopic images acquired from a single pain clinic center during the intervention of 44 cases where US-guided caudal block with a catheter-over-needle had been performed between November 2019 and August 2020 because of lumbosacral origin pain
Fluoroscopic findings confirmed that there was 100% accuracy in catheter placement into the caudal epidural space under US guidance without intravascular uptake
Summary
US has some advantages over fluoroscopy in guiding caudal blocks because it is easy to learn and radiation-free It can be used in virtually any clinical settings [2,3,4]. This study was conducted to investigate the influence of an ultrasound-guided technique using a catheter-over-needle when an intravascular injection occurs in patients undergoing a caudal block. Material and Methods: We retrospectively investigated 41 cases of an ultrasound-guided technique using an angiocatheter for caudal block. These had been performed between November 2019 through August 2020 to manage pain of lumbosacral origin. Results: In all recruited cases, the catheter-over-needle was guided successfully to the sacral hiatus and into the caudal epidural space. Conclusions: The technique of using a catheter-over-needle under ultrasound induced successful block without intravascular injection
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