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

Hong, Ji Hee; Lee, Yong-Ho

doi:10.4097/kjae.2014.67.3.193

Cited by 5 publications

(8 citation statements)

References 22 publications

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“…Although the TF path involves a greater risk for an accidental intravascular injection, this is also possible after an interlaminar injection . Other authors found the incidence of an intravascular pattern for the TF path at the lumbar level between 11.2% and 15.5% and at the cervical level 19.4% . The chance for TF intravascular injection is greater at the S1 level (21.3%) in comparison with the lumbar level (8.1%) …”

Section: Avoidance Of Vascular Injectionmentioning

confidence: 97%

Safe Use of Epidural Corticosteroid Injections: Recommendations of the WIP Benelux Work Group

et al. 2018

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Section: Avoidance Of Vascular Injectionmentioning

confidence: 97%

Safe Use of Epidural Corticosteroid Injections: Recommendations of the WIP Benelux Work Group

et al. 2018

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“…The initial search identified 335 articles in PubMed, 402 in EMBASE, 384 in Web of Science, 335 in MEDLINE complete, and 174 in the Cochrane Library. After the screening of the articles, 25 articles were identified to be associated with intravascular injection, and excluding those related to only one needle type, without transforaminal approach, animal models, review articles, and case reports, three randomized controlled trials and three observational studies were identified for analysis [202122232425]. Fig.…”

Section: Resultsmentioning

confidence: 99%

“…1 shows a flow diagram of the study selection as recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [27]. All six studies performed epidural injection using the transforaminal approach [202122232425]. Four of the six studies reported data at the lumbosacral level [21232425], and one reported data at the S1 level [22].…”

Section: Resultsmentioning

confidence: 99%

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Effect of needle type on intravascular injection in transforaminal epidural injection: a meta-analysis

Kim

Park

et al. 2019

Korean J Pain

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Background Lumbosacral transforaminal epidural injection (TFEI) is an effective treatment for spinal disease. However, TFEI may have several types of complications, some of which can be attributed to intravascular injection. We reviewed studies to compare the intravascular injection rate among different needle types. Methods We searched the literature for articles on the intravascular injection rate among different needle types used in TFEI. The search was performed using PubMed, MEDLINE, the Cochrane Library, EMBASE, and Web of Science. Results A total of six studies comprising 2359 patients were identified. Compared with the Quincke needle, the Whitacre needle reduced the intravascular injection rate (OR = 0.57, 95% CI = [0.44–0.73], P < 0.001). However, compared with the Quincke needle, the Chiba needle did not reduce the intravascular injection rate (OR = 0.80, 95% CI = [0.44–1.45], P = 0.46). In one study, the intravascular injection rate using a blunt-tip needle was lower than that using a sharp needle. In another study, the Whitacre and the blunt-tip needle have similar intravascular injection rates, while, the catheter-extension needle showed a reduced intravascular injection rate. Conclusions This meta-analysis showed that the Whitacre needle reduced the intravascular injection rate as compared with the Quincke needle, but failed to establish that the Chiba needle can decrease the intravascular injection rate in TFEI. Moreover, the blunt-tip needle can reduce the intravascular injection rate compared with the Quincke needle, and the catheter-extension needle can reduce the intravascular injection rate compared with the Whitacre and the blunt-tip needle.

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“…Inadvertent intravascular injection has been suggested as the most probable mechanism behind serious neurological complications during TFESI [4][5][6]. The incidence of inadvertent intravascular injection during TFESI has been estimated to be 6-26% depending on the level of the injection [7][8][9][10][11][12]. A review of current literature reveals several studies evaluating factors involved in intravascular uptake during TFESI such as needle type, level of injection, injection approach, underlying comorbidities and so on.…”

Section: Introductionmentioning

confidence: 99%

Differential rates of intravascular uptake and pain perception during lumbosacral epidural injection among adults using a 22-gauge needle versus 25-gauge needle: a randomized clinical trial

et al. 2020

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Background: Inadvertent intravascular injection has been suggested as the most probable mechanism behind serious neurological complications during transforaminal epidural steroid injections. Authors believe a smaller gauge needle may lead to less intravascular uptake and less pain. Theoretically, there is less chance for a smaller gauge needle to encounter a blood vessel during an injection compared to a larger gauge needle. Studies have also shown smaller gauge needle to cause less pain. The aim of the study was to quantify the difference between a 22-gauge needle and 25-gauge needle during lumbosacral transforaminal epidural steroid injection in regards to intravascular uptake and pain perception. Methods: This was a prospective single blind randomized clinical trial performed at outpatient spine practice locations of two academic institutions. One hundred sixty-two consecutive patients undergoing lumbosacral transforaminal epidural injections from February 2018 to June 2019 were recruited and randomized to each arm of the study-84 patients were randomized to the 22-gauge needle arm and 78 patients to 25-gauge arm. Each transforaminal injection level was considered a separate incidence, hence total number of incidence was 249 (136 in 22-gauge arm and 113 in 25-gauge arm). The primary outcome measure was intravascular uptake during live fluoroscopy and/or blood aspiration. The secondary outcome measure was patient reported pain during the procedure on the numerical rating scale. Results: Fisher exact test was used to detect differences between 2 groups in regards to intravascular uptake and paired t-tests were used to detect differences in pain scores. The incidence of intravascular uptake for a 22-gauge needle was 5.9% (95% confidence interval: 1.9 to 9.8%) and for a 25-gauge needle, 7.1% (95% confidence interval: 2.4 to 11.8%) [p = 0.701]. Average numerical rating scale scores during the initial needle entry for 22-gauge and 25-gauge needle was 3.46 (95% confidence interval: 2.94 to 3.98) and 3.13 (95% confidence interval: 2.57 to 3.69) respectively [p = 0.375]. Conclusions: The study showed no statistically significant difference in intravascular uptake or pain perception between a 22-gauge needle and 25-gauge needle during lumbosacral transforaminal epidural steroid injections. Trial registration: ClinicalTrials.gov NCT04350307. Registered 4/17/2020. (Retrospectively registered).

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

Cited by 5 publications

References 22 publications

Safe Use of Epidural Corticosteroid Injections: Recommendations of the WIP Benelux Work Group

Safe Use of Epidural Corticosteroid Injections: Recommendations of the WIP Benelux Work Group

Effect of needle type on intravascular injection in transforaminal epidural injection: a meta-analysis

Differential rates of intravascular uptake and pain perception during lumbosacral epidural injection among adults using a 22-gauge needle versus 25-gauge needle: a randomized clinical trial

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