Comparison Of Blunt And Sharp Needles For Transforaminal Epidural Steroid Injections

Abstract

Özet Amaç SummaryObjectives: The aim of this study was to compare the sharp and blunt needles in order to determine the incidence of complications during transforaminal anterior epidural steroid injections. Methods: In this retrospective study, 185 cases that undergo transforaminal epidural steroid injection with sharp or blunt needles were evaluated between June 2004 and December 2008. Patients age, sex, diagnosis, needle type (sharp or blunt), volume of local anesthetic and steroid injected, complications (paresthesia, dural puncture, bleeding, paralysis, intravascular penetration, headache, local back pain, temporary motor loss in lower extremities) was recorded. Results: 3 cases in blunt needle group and 8 cases in sharp needle group showed paresthesia during the procedure. The difference was not found to be significant among the groups. Vascular penetration was observed in 2 cases in blunt and 13 cases in sharp needle group and the difference between groups was statistically significant (p<0.001). Dural puncture and headache incidence were not significant when the two groups are compared. The local back pain at the injection site had a higher incidence in the blunt needle group. Conclusion: When using the blunt needles, vascular penetration and paresthesia were less during transforaminal epidural steroid injections. Therefore blunt needles seem to be more advantageous.

Stellate ganglion block: An approach to prevent oesophageal injury

“…[8] Blunt needles seem to be more advantageous because when using them, vascular penetration, and paresthesia were less during transforaminal epidural steroid injections. [9] Use of blunt needles also has been suggested by Graham et al . in cervical transforaminal injections.…”

Epidural Steroid Injections: An Updated Review on Recent Trends in Safety and Complications

“…Blunt tip needles have been shown to reduce the incidence of vascular penetration for transforaminal injections when compared with sharp needles, with an absolute risk reduction of 8.2-11.8% [75,138]. There is also a trend for blunt tip needles to be associated with lower rates of paresthesias, dural puncture and headache, although significance in one study was lacking for these outcomes [75]. No difference in vascular penetration rate has been observed between different types of sharp tip needles [139], obliging practitioners to weigh any perceived advantage of navigation and steering ability against an increased risk of vascular penetration.…”

“…Besides paresthesias, uncomfortable sensations may be blunted in patients with spinal stenosis, masking increases in epidural pressure that can injure the spinal cord [137]. Blunt tip needles have been shown to reduce the incidence of vascular penetration for transforaminal injections when compared with sharp needles, with an absolute risk reduction of 8.2-11.8% [75,138]. There is also a trend for blunt tip needles to be associated with lower rates of paresthesias, dural puncture and headache, although significance in one study was lacking for these outcomes [75].…”

“…[74] † Reference [75] includes data for S1-S2 injections. ‡ Vasovagal rate for cervical transforaminal injection was 1.6% (4/247) in [81].…”

Comparison of incidence of intravascular injections during transforaminal epidural steroid injection using different needle types

“…Nahm et al [ 13 ] and Kim et al [ 14 ] reported that the incidence of vascular injection was significantly increased with cervical and sacral level of injections. Özcan et al [ 15 ] reported that using the blunt needles can reduce the intravascular injection and paresthesia during TFESI. Also, animal studies have demonstrated that the blunt needles are less likely than sharp needles to puncture the vital structures including blood vessels [ 16 ].…”