A blunt needle (Epimed<sup>®</sup>) does not eliminate the risk of vascular penetration during transforaminal epidural injection

Ilkhchoui, Yashar; Koshkin, Eugene

doi:10.4103/2152-7806.120784

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Clinical experience has shown that blunt needles do not offer good directionality and may prolong procedures. A case report in the literature has found that a blunt needle, negative aspiration, or a test dose of the local anesthetic does not offer reliable protection against vascular penetration [ 8 ]. However, in a retrospective study of 185 transforaminal epidural steroid injections, paresthesia was reported in three cases with blunt needles versus eight cases with a sharp needle.…”

Section: Reviewmentioning

confidence: 99%

Iatrogenic Side Effects of Pain Therapies

Gharibo,

Drewes,

Breve

et al. 2023

Cureus

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Pain regimens, particularly for chronic cancer and noncancer pain, must balance the important analgesic benefits against potential risks. Many effective and frequently used pain control regimens are associated with iatrogenic adverse events. Interventional procedures can be associated with nerve injuries, vascular injuries, trauma to the spinal cord, and epidural abscesses. Although rare, these adverse events are potentially catastrophic. Pharmacologic remedies for pain must also consider potential side effects that can occur even at therapeutic doses of over-the-counter remedies such as paracetamol (acetaminophen) or nonsteroidal anti-inflammatory drugs. Opioids are effective pain relievers but are associated with many side effects, some of which can be treatment limiting. A prevalent and distressing side effect of opioid therapy is constipation. Opioid-induced constipation is caused by binding to opioid receptors in the gastrointestinal system, making conventional laxatives ineffective. Peripherally acting mu-opioid receptor antagonists are a new drug class that offers the benefits of preserving opioid analgesia without side effects in the gastrointestinal system. An important safety concern, particularly among geriatric patients is the increasingly prevalent condition of polypharmacy. Many senior patients take five or more medications, including some that may be contraindicated in geriatric patients, duplicative of other drugs, have potential pharmacokinetic drug-drug interactions, or may not be the optimal choice for the patient’s age and condition. Careful assessment of medications in the elderly, including possibly deprescribing with tapering of certain drugs, may be warranted but should be done systematically and under clinical supervision.

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Section: Reviewmentioning

confidence: 99%

Iatrogenic Side Effects of Pain Therapies

Gharibo,

Drewes,

Breve

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…Whilst some of the evidence does suggest blunt needles may be safer, the first cases of spinal cord injury the use of blunt needles are now being reported to be associated with vascular spread [37] The curved, blunt RF (Racz-Finch) needle is being used increasingly in an attempt to avoid intraneural, intracord and intra-arterial placement especially with the use of particulate corticosteroids. Thus far, no cases involving these needles have surfaced.…”

Section: The Debate Over Sharp Versus Blunt Needlesmentioning

confidence: 99%