Younghoon Jeon1, Jungwon Lee2, Hyunho Shin3, Chorong Park3, Kilhyun Kim3, Saeyoung Kim4. 1. Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Korea. 2. Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. 3. Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. 4. Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
Abstract
BACKGROUND:Cervical transforaminal epidural block (CTEB) is a useful option in the diagnosis and treatment of cervical radicular pain. However, inadvertent intravascular injection can lead to severe neurologic complications. Blunt needles are considered to displace instead of penetrate vessels because of their dull needle tip. OBJECTIVES: To investigate whether there is a difference between blunt and sharp needles in 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 for treatment of radicular pain resulting from spinal stenosis and herniated nucleus pulposus were randomly assigned to one of 2 needle groups (blunt needle or sharp needle). The needle position was confirmed using biplanar fluoroscopy, and 2 mL of nonionic contrast medium was injected to detect intravascular injection. Intravascular injection was defined as the contrast medium spreading out through the vascular channel during injection under real-time fluoroscopy. This study was registered in ClinicalTrials.gov. RESULTS: The intravascular injection rate was not significantly different between the blunt needle and sharp needle groups (35.2% vs. 33.3%, P > 0.05). The procedure time was longer 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 be blinded to the type of needle used. CONCLUSIONS: In the present study, use of a blunt needle did not reduce the rate of intravascular injection during CTEB compared to use of a sharp needle. In addition, procedure time significantly increased with blunt needle use compared to sharp needle use. KEY WORDS: Analgesia, bleeding, blunt needle, cervical spine, clinical trials, complications, intravascular injection, radiculopathy, sharp needle, transforaminal epidural block.
RCT Entities:
BACKGROUND: Cervical transforaminal epidural block (CTEB) is a useful option in the diagnosis and treatment of cervical radicular pain. However, inadvertent intravascular injection can lead to severe neurologic complications. Blunt needles are considered to displace instead of penetrate vessels because of their dull needle tip. OBJECTIVES: To investigate whether there is a difference between blunt and sharp needles in 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 for treatment of radicular pain resulting from spinal stenosis and herniated nucleus pulposus were randomly assigned to one of 2 needle groups (blunt needle or sharp needle). The needle position was confirmed using biplanar fluoroscopy, and 2 mL of nonionic contrast medium was injected to detect intravascular injection. Intravascular injection was defined as the contrast medium spreading out through the vascular channel during injection under real-time fluoroscopy. This study was registered in ClinicalTrials.gov. RESULTS: The intravascular injection rate was not significantly different between the blunt needle and sharp needle groups (35.2% vs. 33.3%, P > 0.05). The procedure time was longer 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 be blinded to the type of needle used. CONCLUSIONS: In the present study, use of a blunt needle did not reduce the rate of intravascular injection during CTEB compared to use of a sharp needle. In addition, procedure time significantly increased with blunt needle use compared to sharp needle use. KEY WORDS: Analgesia, bleeding, blunt needle, cervical spine, clinical trials, complications, intravascular injection, radiculopathy, sharp needle, transforaminal epidural block.