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The purpose of this study is to analyze the spread of local anesthetic using magnetic resonance imaging after thoracic 2 paravertebral block in patients with cervical radiculopathy.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Ultrasound probe sagittal group | Experimental | A thoracic 2 paravertebra block is performed with the ultrasound probe placed sagittal and the needle in plane with respect to the probe. |
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| Ultrasound probe transverse group | Active Comparator | A thoracic 2 paravertebra block is performed with the ultrasound probe placed transverse and the needle in plane with respect to the probe. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ultrasound probe sagittal group | Procedure | Place the ultrasound probe vertically against the patient's spine and insert the needle in-plane. The width of insertion of the needle is usually approximately 5 cm from the midline. After the needle penetrates the superior costovertebral ligament and pops, when it reaches the thoracic paravertebral space, perform aspiration and inject 10 mL of 1% lidocaine. At this time, it can be observed in real time as the infusion fluid pushes the bright pleura away from the needle. |
| Measure | Description | Time Frame |
|---|---|---|
| Injectate spread on MRI imge | Presence of injectate on each anatomic target (Paravertebral space, ventral/dorsal epidural space, intercostal nerve, contralateral space) | 1 hour after thoracic 2 paravertebral block |
| Measure | Description | Time Frame |
|---|---|---|
| numeric rating score | A score of 0 indicates no pain and a score of 10 indicates maximum pain. | Before nerve block, after 30 minutes, and thereafter, at the outpatient visit on the 7th day and the outpatient visit on the 28th day. |
| perfusion index |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Do Hyeong Kim | Contact | 82-2-2019-4601 | BREADFANS@yuhs.ac |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Gangnam Severance Hospital | Seoul | South Korea |
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Patients with chronic cervical radiculopathy due to degenerative spinal disease for more than 3 months
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Medical staff performing patient care, including pain management, and investigators who investigate and record observations and evaluations, and those who analyze magnetic resonance imaging, are kept unaware of group assignments.
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| Ultrasound probe transverse group | Procedure | Place the ultrasound probe transverse to the spine and insert the needle in-plane. The reflection of a transverse process is a common landmark. The needle goes in from lateral to in plane. The goal is a triangle between the parietal pleura anteriorly and the internal intercostal membrane and intercostal muscle posteriorly. The final point of the needle is the transition zone from the intercostal to the thoracic paraspinal space, just anterior to the transverse process. When it is confirmed that the tip of the needle has reached the paravertebral space, 10 mL of 1% lidocaine is injected after checking the negative pressure, and after confirming the spread of the drug in real time with ultrasound. |
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After the subject rests in the supine position for about 10 minutes, pulse oximetry is placed on the index finger to record the baseline value. Perfusion index was measured using pulse oximetry (Root®, Masimo Corporation, Irvine, CA, USA). The perfusion index can be a useful indicator for judging the After the subject rests in the supine position for about 10 minutes, pulse oximetry is placed on the index finger to record the baseline value. Perfusion index was measured using pulse oximetry (Root®, Masimo Corporation, Irvine, CA, )
| Before nerve block, after 30 minutes |
| skin temperature | Place a touch thermometer (IntelliVue MP70 patient monitor, Philips Healthcare, Best, Netherlands) on the palm of your hand and measure. Calculate the amount of change from the baseline. Record the difference with the contralateral hand. | Before nerve block, after 30 minutes |
| pinprick and cold test | Pinprick sensation was performed using a 22 gauge short bevel needle. Comparison with the contralateral dermatome. Sensation is rated as 0 (no sensation), 1 (decreased sensation), and 2 (normal). A sensory block is considered successful if the patient reports 0 or 1. Cold sensation is measured in the same way using an ice cube. If there is no difference in the sensation of the treated dermatome compared to the contralateral dermatome. | Before nerve block, after 30 minutes |
| Blood pressure in mmHg | Record blood pressure , and calculate the change from baseline. | Before nerve block, after 30 minutes |
| Pulse rate in /min | Record pulse, and calculate the change from baseline. | Before nerve block, after 30 minutes |
| Presence of adverse events | Horner syndrome, hoarseness, dyspnea, ptosis, dysphagia | Before nerve block, after 30 minutes |
| medication quantification scale | The Medication Quantification Scale (MQS) is an instrument with potential clinical and research applications for quantifying medication regimen use in chronic pain populations. | Before nerve block, and thereafter, at the outpatient visit on the 7th day and the outpatient visit on the 28th day |