Comparison of Intravascular Injection Rate Between Blunt and Sharp Needles During Cervical Transforaminal Epidural Block

摘要

Background: Cervical transforaminal epidural block (CTEB) is a useful option in thediagnosis and treatment of cervical radicular pain. However, inadvertent intravascularinjection can lead to severe neurologic complications. Blunt needles are considered todisplace instead of penetrate vessels because of their dull needle tip.Objectives: To investigate whether there is a difference between blunt and sharp needlesin intravascular injection rates during CTEB.Study Design: Prospective, randomized, clinical trial.Setting: A tertiary hospital in South Korea.Methods: After institutional review board approval, 108 patients undergoing CTEB fortreatment of radicular pain resulting from spinal stenosis and herniated nucleus pulposuswere randomly assigned to one of 2 needle groups (blunt needle or sharp needle). Theneedle position was confirmed using biplanar fluoroscopy, and 2 mL of nonionic contrastmedium was injected to detect intravascular injection. Intravascular injection was defined asthe contrast medium spreading out through the vascular channel during injection under realtime fluoroscopy. This study was registered in ClinicalTrials.gov.Results: The intravascular injection rate was not significantly different between the bluntneedle and sharp needle groups (35.2% vs. 33.3%, P > 0.05). The procedure time waslonger in the blunt needle group than in the sharp needle group (101.00 ± 12.4 seconds vs.56.67 ± 8.3 seconds, P < 0.001).Limitations: This was a single-center study. Additionally, the physicians could not beblinded to the type of needle used.Conclusions: In the present study, use of a blunt needle did not reduce the rate ofintravascular injection during CTEB compared to use of a sharp needle. In addition, proceduretime significantly increased with blunt needle use compared to sharp needle use.