Research on epidural blockade and its control - Riga Stradiņš University

Research on epidural blockade and its control

10:05, 11 June, 2014
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On 16 June at 15:00 in an open meeting of the Medical Promotion Council of Rīga Stradiņš University that will take place in Hippocrates lecture theatre, Riga, 16 Dzirciema Str., Irina Evansa will defend her doctoral thesis “Ultrasound-Assisted Versus Fluroscopic-Controlled Analgesic Epidural Blockade in Patients with Degenerative Diseases of the Spine”.

Doctoral thesis contains comparative analysis of the quality and efficiency of the procedure.

For many years epidural blockade has been used in the treatment of back pain. Steroids are injected in epidural space of the spinal canal with an aim to reach the level of pathologic changes and reduce inflammation process and pain. Currently, American Society of Regional Anesthesia and Pain Medicine recommends to perform this procedure under fluoroscopic guidance to ensure the accuracy of needle placement and delivery of the injected drug in the pathologic place. In Latvia epidural blockades under fluoroscopic guidance are performed solely in a few specialised places, however, in the majority of cases blockades are still performed without the use of visualisation equipment basing on anatomical landmarks. This situation might result from the expensiveness and unavailability of fluoroscopy equipment, as well as radiation risk during the procedure.

For the past five years ultrasonoscopy as a visualisation method in regional anaesthesia has been used more widely in the world with an aim to facilitate the employment of spinal epidural anaesthesia and to avoid fluoroscopic control risks. Still, its application for the treatment of chronic pain is at the state of development.

The aim of the paper was to prove that ultrasonoscopy is an equal visualisation method to fluoroscopy in case of epidural analgesic blockades in patients with back pain and degenerative vertebral diseases. Within the framework of the research, for the first time in Latvia epidural blockades were performed after ultrasonoscopic visualisation of the spine. Data on the quality of epidural blockades performed under the control of ultrasonoscopy and fluoroscopy, technical difficulties and efficiency thereof by detecting anaelgesic action and effect of reducing functional disability were obtained, and side effects and complication risks of epidural blockades were assessed.

The research proves that when performing epidural steroid blockade after ultrasonoscopic visualization of the injection site, analgesic effect and decrease in the functional disability index is comparable with the effect achieved after use of traditional fluoroscopically controlled blockades (“gold” standard in pain medicine) in patients with back pain. After the summary of research data it was concluded that the efficiency of epidural blockade and peculiarities of performance thereof are dependent on patient’s demographic, physical and clinical parameters. The outcome of the procedure depends on patient’s age, body mass index and the number of morphologic changes, as well as such clinical indicators as pain intensity, stage of functional disability and back pain duration. The results show that ultrasound method might serve as an alternative for fluroscopic-controlled epidural steroid injection in case the patient is at increased risk of a reaction to contrast media or in the case of contraindicated or unavailable roentgenoscopy.

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