Original Articles : Analysis of Influencing Factors to Depth of Epidural Space for Lumbar Transforaminal Epidural Block in Korean

( Sung Sick Shin ),( Lee Kyoung Kim ),( Jung Ryul Kim ),( In Ji Kim ),( Bac Ne Kim ),( Gan Tac Hwang ) 대한통증학회 2011 The Korean Journal of Pain Vol.24 No.4

Background: Transforaminal epidural steroid injection is one of the effective treatments in managing radicular pain. There have been some prospective studies on the depth to the epidural space with the transforaminal approach. However, there have been no studies about the depth in Asians, especially Koreans. This study was carried out in order to evaluate the depth to the epidural space and the oblique angle and factors that influence the depth to the epidural space during lumbar transforaminal epidural injection. Methods: A total of 248 patients undergoing fluoroscopically guided transforaminal epidural steroid injections were evaluated. At the L3-4, L4-5, L5-S1, and S1 levels, we measured the oblique angle and depth to the epidural space. Results: Needle depth was positively associated with body mass index (correlation coefficient 0.52, P = 0.004). The median depths (in centimeters) to the epidural space were 6.13 cm, 6.42 cm, and 7.13 cm for 50-60 kg, 60-70 kg, and 70-80 kg groups, respectively, at L5-S1. Age and height were not significantly associated with the needle depth. Conclusions: There is a positive association between the BMI (and weight) and transforaminal epidural depth but not with age, sex, and height.

Analysis of Influencing Factors to Depth of Epidural Space for Lumbar Transforaminal Epidural Block in Korean

Kim, Lee-Kyoung,Kim, Jung-Ryul,Shin, Sung-Sick,Kim, In-Ji,Kim, Bac-Ne,Hwang, Gan-Tac The Korean Pain Society 2011 The Korean Journal of Pain Vol.24 No.4

Background: Transforaminal epidural steroid injection is one of the effective treatments in managing radicular pain. There have been some prospective studies on the depth to the epidural space with the transforaminal approach. However, there have been no studies about the depth in Asians, especially Koreans. This study was carried out in order to evaluate the depth to the epidural space and the oblique angle and factors that influence the depth to the epidural space during lumbar transforaminal epidural injection. Methods: A total of 248 patients undergoing fluoroscopically guided transforaminal epidural steroid injections were evaluated. At the L3-4, L4-5, L5-S1, and S1 levels, we measured the oblique angle and depth to the epidural space. Results: Needle depth was positively associated with body mass index (correlation coefficient 0.52, P = 0.004). The median depths (in centimeters) to the epidural space were 6.13 cm, 6.42 cm, and 7.13 cm for 50-60 kg, 60-70 kg, and 70-80 kg groups, respectively, at L5-S1. Age and height were not significantly associated with the needle depth. Conclusions: There is a positive association between the BMI (and weight) and transforaminal epidural depth but not with age, sex, and height.

한국 영유아 및 소아의 요추부에서의 피부-경막외강 깊이

최종범 ( Jong Bum Choi ),홍정연 ( Jeong Yeon Hong ),김준식 ( Joon Sik Kim ),길혜금 ( Hae Keum Kil ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.5

Background: Lumbar epidural block is now a popular technique for anesthesia and post operative analgesia. It may be helpful for prevention of complication during this procedure to know the depth from the skin to the lumbar epidural space before the procedure. This study was undertaken to evaluate the depth from the skin to the lumbar epidural space and to determine any potential relationship between a patient`s data (age, weight, and height) and the measured depth in Korean children. Methods: We investigated the electronic records of 662 Korean children who were received urologic surgeries with epidural catheterization for postoperative analgesia. The patients` gender, age, weight, height and epidural depth were recorded and analyzed with multiple linear regression test using SPSS 13.0 (SPSS Co., Ilinois, USA). Results: The patient`s age and weight were significantly correlated to the skin-epidural space depth in Korean children. Body weight was more significant variable than age on the epidural depth. The empirical formula derived from the results was as follow; epidural depth (mm)=9+0.5×body weight (kg)-0.2×age (months). Conclusions: We suggest that the depth of skin-lumbar epidural space can be estimated with the empirical formula based on body weight and age. (Korean J Anesthesiol 2009;56:531~4)

한국 성인의 피부에서 요추부 경막외강까지의 깊이

차수만,정용훈,김대성,박진석,강현,백종화,우영철,김진윤,구길회,박선규 대한마취통증의학회 2011 Anesthesia and pain medicine Vol.6 No.1

Background:Lumbar epidural block is a common regional anesthetic/ analgesic technique. The depth of the epidural space beneath the skin surface varies from patient to patient at the same vertebral level. It also varies at different levels of the spinal column in the same patient. This study was performed to evaluate the correlations between the lumbar epidural depth and physical measurements depending on the puncture site. Methods:Data was gathered from 1,653 patients who were undergoing elective lumbar epidural blocks for anesthesia during surgical procedures. The age, gender, height and weight were obtained from the medical records. We calculated the physical parameters such as the weight/height ratio, the body mass index (BMI) and Broca`s index. Pearson’s correlation analysis and regression testing between the lumbar epidural depth and the physical measurements were performed. Results:The epidural depths at the L2-3, L3-4, L4-5 and L5-S1 intervertebral space were 4.4 ± 0.62, 4.6 ± 0.69, 4.6 ± 0.69 and 4.1 ± 0.52 cm, respectively. A significant correlation was found between the epidural depth and the weight/height ratio and BMI. Conclusions:The weight/height ratio and BMI showed the highest correlation with the lumbar epidural depth. (Anesth Pain Med 2011; 6: 16∼20)

피부표면에서 경막외강까지의 거리

김성주,김철호,신동엽,문순홍,홍기혁 인제대학교 1995 仁濟醫學 Vol.16 No.3

1994년 3월부터 1994년 8월까지 인제대학교 상계백병원 마취과에서 경막외 마취 및 통증 완화를 목적으로 경막외 카테터 삽입을 시행한 589명을 대상으로 하여 피부에서 경막외강까지의 거리를 측정함으로써 경막외강에 카테터를 정확하게 거치시키는데 도움을 주고자 문헌 고찰과 함께 보고하고자 한다. Lumbar epidural analgesia is a well established method for providing postoperative pain relief. Placement of a needle in the epidural space is probably one of the two technically demanding procedures performing by anesthesiologists. Authors studied 589 patients who received epidural analgesia for postoperative pain control. The distance to the epidural space from skin surface was measured by 18G Tuohy needle with marks at each 1cm from the tip. The mean distance was appeared to be 3.92cm, which was correlated with other anatomic measurements, but it was varied with the lumbar inter-space measured. Most epidural spaces were identified at 3 to 5cm and 92.4% of the cases were less than 5cm. This study suggests that if the epidural space has not been identified within a depth of 6cm, redirection or re-insertion of the needle should be considered.

Appropriate angle and depth in thoracic transforaminal epidural block in Koreans

노찬,이원형,고영권,이선열,김여정,이승훈,정춘호,강혜민 대한마취통증의학회 2018 Anesthesia and pain medicine Vol.13 No.4

Background: Selective transforaminal epidural block has come to the for as a targetspecific modality in the treatment and diagnosis of spinal pain. Thoracic transforaminal epidural block (TTFEB) has the associated risk of pneumothorax. This article describes a retrospective study conducted using computed tomography (CT) imaging to investigate the TTFEB angle and depth appropriate to minimize the risk of pneumothorax in Koreans. Methods: The subjects of the present study were 100 randomly selected patients between 50 and 70 years of age found be free of thoracic disease according to chest CT performed in the present hospital. On the chest CT, the superior, middle, and inferior thoracic vertebrae were observed at the T2, T7, and T11 levels, respectively. Results: The average distance and the needle insertion angle from the skin point at which the needle may be inserted without piercing the lung to the intervertebral foramen were 117.8 ± 12.1 mm and 58.1 ± 6.1° at the T2 level, 85.6 ± 10.0 mm and 61.7 ± 4.3° at the T7 level, and 94.3 ± 8.7 mm and 64.4 ± 7.0° at the T11 level, respectively. Conclusions: The needle insertion at the point further than 40 mm, on the upper, middle thorax, if the needle pass from the inner vertebral body to lamina, it could be safer. However, on the lower thorax, needle could pierce the lung though the needle start from the inner vertebral body. Thus, it can be safer if the needle pass toward the exterior margin of lamina.

노인 환자에서 경막외강의 깊이

정용훈 ( Yong Hun Jung ),박정원 ( Jung Won Park ) 대한통증학회 2004 The Korean Journal of Pain Vol.17 No.1

성인 여성의 피부에서 고위 흉추 경막외강까지의 깊이

정민규 ( Min Gue Chung ),옥시영 ( Si Young Ok ),김순임 ( Soon Im Kim ),김선종 ( Sun Chong Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.5