Poster 244: Influence of Needle Type on the Incidence of Intravascular Injection During Lumbosacral Transforaminal Epidural Injections: A Comparison of Short Bevel and Long Bevel Needles

Abstract

Objective: To determine if the incidence of intravascular injection differs between short bevel and long bevel needles during lumbosacral transforaminal epidural injections. Design: Prospective, observational comparison study. Setting: University spine center. Participants: 77 consecutive consenting patients scheduled to receive lumbar transforaminal epidural injections. Subjects had a mean age of 49.7 years (range, 21–91y), 43% were men and 57% women. Interventions: One physician performed 157 fluoroscopically-guided lumbosacral transforaminal epidural injections on the 77 study participants. For each injection the dynamic flow of contrast was observed under live fluoroscopy and the presence or absence of vascular patterns was recorded. Main Outcome Measures: The Fisher exact test was used to determine the significance of variance in the incidence of vascular contrast patterns observed in the injections performed with short bevel needles compared with long bevel needles. Results: Of the 157 injections, 58 were performed using short bevel (chiba point) needles and 99 using long bevel (quincke point) needles. Vascular injections were observed in 22 of the 157 injections for an overall incidence of 14.0%. The incidence of vascular injections with short bevel needles was 17.2% (10 out of 58) and with long bevel needles was 12.1% (12 out of 99). This difference was not statistically significant at P=0.364. Conclusions: Potential complications related to accidental intravascular penetration during transforaminal epidural injections has piqued interest in the relative safety of sharp versus blunt needles. This is the first study to report on the incidence of inadvertent intravascular injection with short bevel needles in comparison with long bevel needles, finding no difference in the incidence between these 2 needle types.