Influence of needle type on the incidence of intravascular injection during transforaminal epidural injections: a comparison of short-bevel and long-bevel needles

Smuck, Matthew; Yu, Andrew J.; Tang, Chi-Tsai; Zemper, Eric D.

doi:10.1016/j.spinee.2009.12.018

Cited by 29 publications

(26 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…13,14 The Whitacre needle was originally designed to reduce the incidence of postdural puncture headaches, not to avoid IV injection. 22 Nevertheless, Shin et al showed that the incidence of IV uptake during S1 TFESI was significantly higher with the Quincke needle (24.9%) than with the Whitacre needle (16.7%) under real-time fluoroscopy.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Joo

Kim

Lee

et al. 2016

Regional Anesthesia and Pain Medicine

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…10 In previous reports, the use of a blunt needle was thought to reduce the rate of IV injection. 13,14 Blunt needles with a pencilpoint tip, such as Whitacre needles, are not as sharp at their tip as are Quincke needles, which have bevels. Blunt needles may therefore be less likely to penetrate a vessel during a procedure.…”

mentioning

confidence: 99%

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

Joo

Kim

Lee

et al. 2016

Regional Anesthesia and Pain Medicine

View full text Add to dashboard Cite

show abstract

“…These injections are generally considered to be safe with a reported incidence of minor complications in the lumbar spine of up to 9.6%. [37]…”

Section: Discussionmentioning

confidence: 99%

“…[1] Using a blunt needle rather than a sharp needle has been suggested to reduce this risk. [7] Although successfully utilized in animal studies, this case report uniquely describes the risk of intravascular injection using a blunt needle (Epimed ® ) in a 59-year-old female who underwent an L5-S1 transforaminal epidural steroid injection (TFESI) under fluoroscopic guidance.…”

Section: Introductionmentioning

confidence: 99%

A blunt needle (Epimed^®) does not eliminate the risk of vascular penetration during transforaminal epidural injection

Ilkhchoui

Koshkin²

2013

Surg Neurol Int

View full text Add to dashboard Cite

Background:Transforaminal epidural injection of local anesthetics and corticosteroids is a common practice in patients with radicular pain. However, serious morbidity has also been reported, which can be attributed to an arterial or venous injection of the medication especially particulate glucocorticoid preparations. Using a blunt needle in contrast to sharp needle has been suggested to reduce this risk in a study on animals.Case Description:We present a 59-year-old female with L5 lumbar radicular symptoms and left L5-S1 foraminal narrowing who underwent transforaminal epidural injection with fluoroscopic guidance using a 22-gauge blunt curved needle (Epimed®, Johnstown, NY). Intravascular needle placement was detected during real-time contrast injection under live fluoroscopy after a negative aspiration and local anesthetic test dose. The needle was slightly withdrawn and correct distribution of the contrast was confirmed along the target nerve root and into the epidural space.Conclusion:This case report discusses vascular penetration utilizing an Epimed® blunt needle to perform transforaminal injections in a clinical setting. This topic was previously discussed in earlier animal studies. We also reemphasize that neither negative aspiration or local anesthetic test doses are reliable techniques to ensure the safety of transforaminal epidural injections.

show abstract

“…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.…”

Section: Conclusion and Future Perspectivementioning

confidence: 99%

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

Bicket

Chakravarthy²,

Chang³

et al. 2015

Pain Manag.

View full text Add to dashboard Cite

Epidural steroid injections (ESIs), which can provide significant but temporary pain relief in well-selected patients, are the most commonly performed procedure in pain management. The anatomy of the epidural space provides a framework for understanding risks associated with ESIs, a topic relevant to both patients and physicians in interventional pain, surgery and primary care. Safety considerations of epidural steroids include drug preparation and myriad physiological effects stemming from steroid exposure. Although major complications associated with ESI occur rarely, potentially catastrophic events resulting from infectious, hematologic and neurologic morbidity may lead to permanent injury. The safety profile of ESIs may improve with development and dissemination of sound injection technique, safer compounds manufactured in a sterile manner and deficient of thromboembolic potential and the application of existing technology.

show abstract

Influence of needle type on the incidence of intravascular injection during transforaminal epidural injections: a comparison of short-bevel and long-bevel needles

Cited by 29 publications

References 13 publications

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

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

A blunt needle (Epimed^®) does not eliminate the risk of vascular penetration during transforaminal epidural injection

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

Contact Info

Product

Resources

About

Influence of needle type on the incidence of intravascular injection during transforaminal epidural injections: a comparison of short-bevel and long-bevel needles

Cited by 29 publications

References 13 publications

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

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

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

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

Contact Info

Product

Resources

About

A blunt needle (Epimed^®) does not eliminate the risk of vascular penetration during transforaminal epidural injection