• Ji Hee Hong, Ji Hoon Park, and Ki Beom Park.
• Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea.
• Pain Physician. 2022 Mar 1; 25 (2): E263-E269.

BackgroundNormal saline or contrast medium is one of the widely used injection materials during fluoroscopic guided injections. Optic nerve sheath diameter (ONSD) measurement is a reliable and noninvasive method for intracranial pressure evaluation.ObjectivesThe purpose of this study was to compare the increase in ONSD and cerebral oxygen saturation (rSO2) between normal saline and contrast medium when they were injected into the epidural space.Study DesignProspective randomized trial.SettingAn interventional pain management clinic in South Korea.MethodsThis study included 42 patients who were scheduled to receive thoracic epidural catheterization for postoperative pain control. Patients were randomly allocated to receive 5 mL normal saline or contrast medium following successful thoracic epidural entry. The ONSD was measured using transorbital sonography at baseline (T0), 10 min (T10), 20 min (T20), and 40 min (T40) after epidural normal saline or contrast medium injection.ResultsBoth groups demonstrated significant increases in ONSD from T10 to T40 when compared with the baseline. Although both groups showed a significant increase in ONSD compared with the baseline, group saline showed a higher increase in ONSD than group contrast. A significantly higher increase in ONSD in group saline than in group contrast was maintained from T10 to T40 (P = 0.015).LimitationsWe could not determine the returning point of the normalized ONSD value.ConclusionThoracic epidural injection of 5 mL normal saline or contrast medium resulted in a significant increase of ONSD compared to baseline; however, the degree of ONSD increase was more attenuated in the contrast group than the saline group.

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