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

Abstract

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.

Comparison of Whitacre needle and Chiba needle on the incidence of intravascular injection during caudal epidural injections

“…In the previous studies, blunt tip needle and pencil type needle have benefits in reducing the incidence of vascular injection during lumbar TFEI, compared with Quincke needle. [ 11 – 13 ] Whitacre needle and blunt tip needle have similar risk of intravascular injection during lumbar TEFI. [ 21 ] Whitacre needle has a tapering pencil-point tip and side hole, which can slide by the vessel without penetration.…”

“…[ 11 ] It was shown that the incidence of intravascular injection was significantly lower in Whitacre needle, compared with Quincke needle during lumbar TEFI (5.4% vs 16.2%). [ 13 ] However, it is not clear that which type of needle is better to reduce intravascular injection. It was reported that blunt needle is more beneficial than sharp needle during TEFI (2.4% vs 13.3%).…”

“…The different needle type can affect the incidence of intravascular injection during transforaminal epidural injection (TFEI). [ 11 – 13 ] Whitacre type needle has a pencil point needle tip with side hole. It is reported that Whitacre needle is effective to decrease the incidence of intravascular injection during TFEI, compared with Quincke needle.…”

“…It is reported that Whitacre needle is effective to decrease the incidence of intravascular injection during TFEI, compared with Quincke needle. [ 11 – 13 ] Quincke needles and Chiba needles have a sharp cutting tip with different angle of bevel. Quincke needle (20° bevel angle) is a long bevel needle whilst Chiba needle (35° bevel angle) is a short bevel needle.…”

Spinal Injections

“…Some studies have shown superiority of one needle type for specific procedures with respect to outcomes such as epidural contrast spread, fluoroscopy time, and complication rates, such as intravascular injection. [24][25][26][27] We maintain that in the hands of a trained proceduralist, spinal injections are safe and effective, and needle choice remains at the discretion of the performing physician based on comfort and technique.…”