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

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 mid-thoracic epidural access; however, evidence on its utility is lacking. Therefore, we aimed to evaluate the clinical usefulness of the CLO view at 60 degrees +/- 5 degrees compared with the lateral (LAT) view using fluoroscopic-guided mid-thoracic 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 satisfaction, 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 signi?cantly 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 degrees +/- 5 degrees increased the success rate and patient satisfaction and reduced the procedural time and patient discomfort compared with the LAT view when performing mid-thoracic epidural access. Therefore, the CLO view at 60 degrees +/- 5 degrees can be considered for mid-thoracic epidural access under fluoroscopic guidance.

Automated summary

The study showed that using the 60 degrees +/- 5 degrees CLO view in fluoroscopic-guided mid-thoracic epidural access can increase success rate and patient satisfaction, and reduce procedural time and patient discomfort.