Impact of Type of Needle on Incidence of Intravascular Injection During Diagnostic Lumbar Medial Branch Block

Joo, Young Bin; Kim, Yong Chul; Lee, Sang Chul; Kim, Hye Young; Park, Keun Suk; Choi, Eun Joo; Moon, Jee Youn

doi:10.1097/aap.0000000000000381

Cited by 7 publications

(10 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Many practitioners perform contrast injections to nullify vascular involvement and to decrease false‐negative outcomes. However, intravascular injection is uncommon with this procedure, and vascular intrusion of commonly applied doses would rarely cause systemic effects [12,13]. Intravascular administration may increase negative response, but volume overadministration may produce a false‐positive response.…”

Section: Discussionmentioning

confidence: 99%

Lumbar Medial Branch Block Volume‐Dependent Dispersion Patterns as a Predictor for Ablation Success: A Cadaveric Study

Wahezi

Alexeev

Georgy

et al. 2017

PM&R

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Lumbar Medial Branch Block Volume‐Dependent Dispersion Patterns as a Predictor for Ablation Success: A Cadaveric Study

Wahezi

Alexeev

Georgy

et al. 2017

PM&R

View full text Add to dashboard Cite

show abstract

“…Aspirating for blood prior to injection has high specificity (97%; 95% CI 95.6% to 98.4%) but low sensitivity (41%; 95% CI 29.2% to 53.7%), making it a poor screening tool. 274 When contrast is injected, it should ideally be performed using real-time fluoroscopy, as spot radiographs have a 59% sensitivity compared with live contrast injection. 272 However, digital subtraction angiography is considered the reference standard for vascular uptake.…”

Section: Question 15: What Are the Most Common Complications Of Facetmentioning

confidence: 99%

“… 106 The type of needle can also affect intravascular uptake during MBB, with one study showing a lower incidence with a pencil-point than a cutting needle (pencil-point needles may also carry a lower incidence of backache, which could result in a lower false-negative rate). 274 275 Guidelines endorsed by SIS also recommend pre-injection of contrast with low volumes, between 0.1 and 0.3 mL, in order to detect venous uptake and ensure the adequacy of spread. 16…”

Section: Question 15: What Are the Most Common Complications Of Facetmentioning

confidence: 99%

Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group

Cohen

Bhaskar

Bhatia

et al. 2020

Reg Anesth Pain Med

Self Cite

216

215

View full text Add to dashboard Cite

BackgroundThe past two decades have witnessed a surge in the use of lumbar facet blocks and radiofrequency ablation (RFA) to treat low back pain (LBP), yet nearly all aspects of the procedures remain controversial.MethodsAfter approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, letters were sent to a dozen pain societies, as well as representatives from the US Departments of Veterans Affairs and Defense. A steering committee was convened to select preliminary questions, which were revised by the full committee. Questions were assigned to 4–5 person modules, who worked with the Subcommittee Lead and Committee Chair on preliminary versions, which were sent to the full committee. We used a modified Delphi method, whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chair, who incorporated the comments and sent out revised versions until consensus was reached.Results17 questions were selected for guideline development, with 100% consensus achieved by committee members on all topics. All societies except for one approved every recommendation, with one society dissenting on two questions (number of blocks and cut-off for a positive block before RFA), but approving the document. Specific questions that were addressed included the value of history and physical examination in selecting patients for blocks, the value of imaging in patient selection, whether conservative treatment should be used before injections, whether imaging is necessary for block performance, the diagnostic and prognostic value of medial branch blocks (MBB) and intra-articular (IA) injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for a prognostic block, how many blocks should be performed before RFA, how electrodes should be oriented, the evidence for larger lesions, whether stimulation should be used before RFA, ways to mitigate complications, if different standards should be applied to clinical practice and clinical trials and the evidence for repeating RFA (see table 12 for summary).ConclusionsLumbar medial branch RFA may provide benefit to well-selected individuals, with MBB being more predictive than IA injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of more false-negatives. Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice.

show abstract

“…Based on our findings we suggest that injected volumes above 0.25 mL may increase false positive rates; therefore, we advocate for low volume, high concentration agents when performing cervical MBBs. As described in various other nerve blocks, when using lower total volume we recommend using a higher concentration of local anesthetic such as 4% lidocaine or 0.75% bupivacaine, as the higher concentration preserves sensory blockade characteristics whereas the lower volume minimizes the effect on surrounding nerves . The data obtained in this cadaveric study expose how 0.25 mL volume injectate may result in increased diagnostic precision, because the spread of 0.25 mL anatomically represents RFA lesion characteristics more accurately than higher volumes of 0.5 mL (Figure A–C).…”

Section: Discussionmentioning

confidence: 64%

Cervical Medial Branch Block Volume Dependent Dispersion Patterns as a Predictor for Ablation Success: A Cadaveric Study

Wahezi¹,

Molina

Alexeev

et al. 2019

PM&R

View full text Add to dashboard Cite

Background: Neck pain is one of the most common causes of chronic pain and the fourth leading cause of disability worldwide; it is estimated that between 36% and 67% of this pain is due to facet arthropathy. For patients who have pain refractory to conservative treatments literature supports management with diagnostic cervical medial branch blocks (MBBs) to identify the associated facet innervation as the source of pain followed by therapeutic radiofrequency ablation (RFA) of the identified nerves. Cervical RFA has good published outcomes; however, the procedure is dependent upon the specificity of the diagnostic block to achieve maximal success. Currently, this prerequisite test has false positive rates between 27% and 63% and recent studies have shown that this may, in part, be a consequence of currently accepted injection volumes of 0.50 mL or more, which may decrease the sensitivity of MBBs. Objective: To evaluate the possible differences in volume dispersion between 0.25 and 0.50 mL of injectate during cervical MBBs. Study Design: Cadaveric study. Setting: An academic medical center in the United States. Patients: Not applicable. Methods: This was a cadaveric study in which six subjects were chosen with intact cervical spines. Cervical MBB were performed bilaterally at the midcervical spine, using a posterior approach under fluoroscopic guidance. 0.25 or 0.50 mL of a 9:1 solution of Omnipaque 180 mg iodine/mL and 1% medical grade methylene blue were administered on the left and right sides, respectively. Postinjection computed tomography (CT) imaging and gross dissection were performed to assess injectate spread. Main Outcome Measures: Outcome measures after using commonly injected volumes for cervical MBB, included visualized and measured spread (by CT and gross dissection) of cervical medial branch blocks, coating adjacent structures not targeted by RFA. Results: Postinjection CT imaging and cadaveric dissection demonstrated that, although both volumes adequately coated the medial branches, the 0.50 mL cohort reliably spread dorsally to superficial muscles (splenius) and nerves distant from the targeted nerves (dorsal motor branches to splenius), whereas the 0.25 mL injectate cohort was contained in the deep and intermediate muscular cervical layers directly juxtaposed to the targeted cMBBs. Conclusion: Results suggest that 0.50 mL injections of local anesthetic during cervical MBBs contacts many nonintended targets, thus decreasing the specificity of a targeted diagnostic cervical MBB. Furthermore, we demonstrated that 0.25 mL of injectate reliably bathed the cervical medial branches without extensive extravasation. This indicates that there would potentially be fewer local anesthetic effects on distant tissues, increasing the specificity of cervical MBBs and likely improving RFA planning.

show abstract

Impact of Type of Needle on Incidence of Intravascular Injection During Diagnostic Lumbar Medial Branch Block

Cited by 7 publications

References 28 publications

Lumbar Medial Branch Block Volume‐Dependent Dispersion Patterns as a Predictor for Ablation Success: A Cadaveric Study

Lumbar Medial Branch Block Volume‐Dependent Dispersion Patterns as a Predictor for Ablation Success: A Cadaveric Study

Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group

Cervical Medial Branch Block Volume Dependent Dispersion Patterns as a Predictor for Ablation Success: A Cadaveric Study

Contact Info

Product

Resources

About