Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Korea.
Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Pain Physician. 2019 May;22(3):265-270.
Cervical transforaminal epidural block (CTEB) is a useful option in the diagnosis and treatment of cervical radicular pain. However, inadvertent intravascular injection can lead to severe neurologic complications. Blunt needles are considered to displace instead of penetrate vessels because of their dull needle tip.
To investigate whether there is a difference between blunt and sharp needles in intravascular injection rates during CTEB.
Prospective, randomized, clinical trial.
A tertiary hospital in South Korea.
After institutional review board approval, 108 patients undergoing CTEB for treatment of radicular pain resulting from spinal stenosis and herniated nucleus pulposus were randomly assigned to one of 2 needle groups (blunt needle or sharp needle). The needle position was confirmed using biplanar fluoroscopy, and 2 mL of nonionic contrast medium was injected to detect intravascular injection. Intravascular injection was defined as the contrast medium spreading out through the vascular channel during injection under real-time fluoroscopy. This study was registered in ClinicalTrials.gov.
The intravascular injection rate was not significantly different between the blunt needle and sharp needle groups (35.2% vs. 33.3%, P > 0.05). The procedure time was longer in the blunt needle group than in the sharp needle group (101.00 ± 12.4 seconds vs. 56.67 ± 8.3 seconds, P < 0.001).
This was a single-center study. Additionally, the physicians could not be blinded to the type of needle used.
In the present study, use of a blunt needle did not reduce the rate of intravascular injection during CTEB compared to use of a sharp needle. In addition, procedure time significantly increased with blunt needle use compared to sharp needle use.
Analgesia, bleeding, blunt needle, cervical spine, clinical trials, complications, intravascular injection, radiculopathy, sharp needle, transforaminal epidural block.
颈椎椎间孔硬膜外阻滞 (CTEB) 是诊断和治疗颈椎神经根痛的有效选择。然而，意外的血管内注射可导致严重的神经并发症。由于钝针的针尖钝，因此被认为会移位而不是穿透血管。
研究 CTEB 中钝针和锐针在血管内注射率方面是否存在差异。
前瞻性、随机、临床试验。
韩国一家三级医院。
在机构审查委员会批准后，108 例因脊柱狭窄和椎间盘突出导致神经根痛而行 CTEB 治疗的患者被随机分配到两组之一（钝针或锐针）。使用双平面荧光透视术确认针尖位置，并注射 2 mL 非离子型造影剂以检测血管内注射。血管内注射定义为在实时荧光透视下注射时造影剂通过血管通道扩散。本研究已在 ClinicalTrials.gov 注册。
钝针组和锐针组的血管内注射率无显著差异（35.2% vs. 33.3%，P > 0.05）。钝针组的操作时间明显长于锐针组（101.00 ± 12.4 秒 vs. 56.67 ± 8.3 秒，P < 0.001）。
这是一项单中心研究。此外，医生无法对使用的针类型进行盲法。
在本研究中，与使用锐针相比，使用钝针并未降低 CTEB 期间的血管内注射率。此外，与使用锐针相比，使用钝针会显著增加操作时间。
镇痛，出血，钝针，颈椎，临床试验，并发症，血管内注射，神经根病，锐针，椎间孔硬膜外阻滞。
