Comparison of the contralateral oblique view with the lateral view for mid-thoracic epidural access under fluoroscopic guidance: a randomized controlled trial

Abstract

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 midthoracic 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 midthoracic 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 satisfation, 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 atisfaction and reduced the procedural time and patient discomfort compared with the LAT view when performing midthoracic epidural access. Therefore, the CLO view at 60°±5° can be considered for mid-thoracic epidural access under fluoroscopic guidance.