Sciatica
Conditions
Keywords
Scan control, Epidural infiltration, visual analogue scale (VAS)
Brief summary
The aim of this care protocol is to study the effects of scan to help epidural infiltration realization, in presumed difficult patients suffering from sciatica. These scans are already performed in our Rheumatology Department but our objective is to evaluate objectively its contribution for patients and doctors. Epidural infiltration in young patients, with an easy anatomical identification, causes generally no technical difficulties, therefore this protocol will only include patients presumed to have a difficult infiltration, that means those aged more than 60, and/or with BMI \> 30 and/or suffering from scoliosis. This study concerns patients who are hospitalized in Rheumatology Department (Hospital of Nantes) for their first epidural infiltration for treatment-resistant lombosciatica. Patient will be randomized at Day 0, before infiltration. This latter will be performed in accordance to current practice. Tolerance data (pain and satisfaction) will be collected just after the infiltration and eventual complications will be reported within 48 hours after infiltration. Following treatment of lombosciatic will be realized through hospitalization, as usual. Scan is a safe, non invasive, painless and non radiating exam. It is the extension of the musculoskeletal clinical exam and it has already changed our rheumatology practices. The investigators hope at the end of this study, that results would confirm that scan can be a help in practice to perform epidural infiltrations.
Interventions
PROCEDUREGroup with scan prior to infiltration
Scan will be conducted by the operator performing the gesture. He will examine the lumbar spine from L3 to S1, in longitudinal and cross sections and determine the best surgical approach. This will be defined by the largest interspinous space or better visibility of the epidural space. The depth of the epidural space will be noted. The selected stage will be marked with a skin pen to facilitate its location thereafter
PROCEDUREGroup without scan
Sponsors
Nantes University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Major patients hospitalized in Rheumatology Department for performing their first epidural infiltration when sciatica is resistant to medical treatment. * Inclusion of patients older than 60 years and / or BMI superior to 30 and / or scoliosis
Exclusion criteria
* Refusal to participate * History of spinal surgery * Anticoagulant or antiplatelet * History of spinal malformations type spina bifida * pregnancy * Age\<18 * Patients under guardianship * Patients participating to another clinical trial (except non interventional trials) * Patients unable to achieve the protocol, in the judgment of the investigator
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Visual analogue scale measuring the pain during infiltration | 10min after the infiltration | To evaluate if scan prior to epidural infiltration could improve its tolerance |
Secondary
| Measure | Time frame |
|---|---|
| Epidural space visibility L3-L4, L4-L5 and L5-S1: 0 for no visibility , 1 for mild , 2 for good | 10min after the infiltration |
| Infiltration evaluation: procedure time between skin passage and release of the needle | 10min after the infiltration |
| Infiltration evaluation: attempts number before correct positioning of needle | 10min after the infiltration |
| Infiltration evaluation: number of puncture sites | 10min after the infiltration |
| Minimal interspinous distance (mm) L3-L4, L4-L5 and L5-S1 | 10min after the infiltration |
| Infiltration tolerance : VAS for pain (graduating from 0 to 10) | 48 hours |
| Infiltration tolerance : infiltration complications (headaches, pain at the puncture site, other) | 48 hours |
| Distance skin- épidural space (mm) L3-L4, L4-L5 and L5-S1 | 10min after the infiltration |
| Epidural space accessibility L3-L4, L4-L5 and L5-S1 : 0 for no visibility , 1 for mild , 2 for good | 10min after the infiltration |
| Infiltration evaluation: number of failures | 10min after the infiltration |
Countries
France
Outcome results
None listed