Department of Anesthesiology and Pain Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (the Republic of).
Department of Anesthesiology and Pain Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (the Republic of)
Reg Anesth Pain Med. 2021 Aug;46(8):694-698. doi: 10.1136/rapm-2021-102504. Epub 2021 May 26.
Transforaminal epidural steroid injection is widely used in clinical practice to effectively deliver injectate into the ventral epidural space. Complications associated with intravascular injection such as spinal cord infarction and paraplegia can occur during transforaminal epidural steroid injection. To improve the safety of the procedure, avoidance of intravascular injection is crucial, for which appropriate needle selection is important. The primary aim of this study was to compare intravascular injection rates during transforaminal epidural steroid injection between commonly used Quincke and Tuohy needles.
Two hundred and four transforaminal epidural steroid injection cases were randomly assigned to one of two needle groups (22-gage Quincke needle or 22-gage Tuohy needle). Intravascular injection was evaluated using digital subtraction angiography. Spread of contrast medium to the ventral and medial epidural spaces was evaluated. Procedure time was compared between the two needle types.
The overall incidence of intravascular injection was 7.8%. The rate of intravascular injection was significantly lower in the Tuohy needle group than the Quincke needle group (2.9% vs 12.7%, p=0.009). The ventral and medial epidural spread rates of the Tuohy needle group were 92.2% and 95.1%, respectively, significantly higher than those of the Quincke needle group. The procedure time was shorter in the Tuohy needle group than in the Quincke needle group (97.4 (19.3) seconds vs 117.8 (31.9) s; mean difference -20.40 (95% CI -34.35 to -6.45), p=0.005).
In conclusion, Tuohy needles had a lower intravascular injection rate and higher medial and ventral epidural spreading rates than Quincke needles.
KCT0002095.
经椎间孔硬膜外类固醇注射在临床实践中被广泛用于将注射剂有效地递送至腹侧硬膜外间隙。在经椎间孔硬膜外类固醇注射过程中，可能会发生与血管内注射相关的并发症，如脊髓梗死和截瘫。为了提高该手术的安全性，避免血管内注射至关重要，而合适的针头选择很重要。本研究的主要目的是比较常用的 Quincke 针和 Tuohy 针在经椎间孔硬膜外类固醇注射过程中的血管内注射率。
将 204 例经椎间孔硬膜外类固醇注射病例随机分为两组（22 号 Quincke 针或 22 号 Tuohy 针）。使用数字减影血管造影术评估血管内注射情况。评估对比剂向腹侧和内侧硬膜外间隙的扩散情况。比较两种针头类型的手术时间。
总的血管内注射发生率为 7.8%。Tuohy 针组的血管内注射率明显低于 Quincke 针组（2.9%比 12.7%，p=0.009）。Tuohy 针组的腹侧和内侧硬膜外扩散率分别为 92.2%和 95.1%，明显高于 Quincke 针组。Tuohy 针组的手术时间明显短于 Quincke 针组（97.4（19.3）秒比 117.8（31.9）秒；平均差值-20.40（95%置信区间-34.35 至-6.45），p=0.005）。
总之，Tuohy 针的血管内注射率低于 Quincke 针，而内侧和腹侧硬膜外扩散率高于 Quincke 针。
KCT0002095。
