Ultrasound-guided facet block to low back pain: a case report

Revista Brasileira de Anestesiologia

Ana Ellen Q. Santiago¹  Plinio C. Leal¹  Elmiro Helio M. Bezerra¹  Ana Laura A. Giraldes¹  Leonardo C. Ferraro¹  Andre H. Rezende¹  Rioko Kimiko Sakata¹ 

关键词: Facet block;    Low back pain;    Ultrasound;    Bloqueio facetário;    Lombalgia;    Ultrassom;    Bloqueo facetario;    Lumbalgia;    Ultrasonido;   

DOI  :  10.1016/j.bjane.2012.09.006

来源: SciELO

【 摘 要 】

BACKGROUND: Osteoarthrosis is a common cause of low back pain. The diagnosis is clinical and can be confirmed by imaging studies. Pain treatment and confirmation of diagnosis are made by intra-articular injection of corticosteroid and by local anesthetic use, due to clinical improvement. A direct monitoring of the procedure can be done under fluoroscopy, a classic technique, or else by an ultrasound-guided procedure. CASE REPORT: Female patient, 88 years old, 1.68 m and 72 kg, with facet osteoarthrosis at L2-L3, L3-L4 and L4-L5 for two years. On physical examination, she exhibited pain on lateralization and spinal extension. We opted in favor of an ultrasound-guided facet joint block. A midline spinal longitudinal scan was obtained, with identification of the desired joint space at L3-L4. A 25 G needle was inserted into the skin by the echographic off-plane ultrasound technique. 1 mL of contrast was administered, with confirmation by fluoroscopy. After aspiration of the contrast, 1 mL of solution containing 0.25% bupivacaine hydrochloride and 10 mg of methylprednisolone acetate was injected. Injections into L3-L4, L2-L3 and L1-L2 to the right were applied. CONCLUSIONS: The visualization of the facet joint by ultrasound involves minimal risk, besides reduction of radiation. This option is suitable for a large part of the population. However, fluoroscopy and computed tomography remain as monitoring techniques indicated for patients with specific characteristics, such as obesity, severe degenerative diseases and anatomical malformations, in which the ultrasound technique is still in need of further study.

【 授权许可】

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