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- Title
Differential rates of intravascular uptake and pain perception during lumbosacral epidural injection among adults using a 22-gauge needle versus 25-gauge needle: a randomized clinical trial.
- Authors
Raju, Robin; Mehnert, Michael; Stolzenberg, David; Simon, Jeremy; Conliffe, Theodore; Gehret, Jeffrey
- Abstract
Background: Inadvertent intravascular injection has been suggested as the most probable mechanism behind serious neurological complications during transforaminal epidural steroid injections. Authors believe a smaller gauge needle may lead to less intravascular uptake and less pain. Theoretically, there is less chance for a smaller gauge needle to encounter a blood vessel during an injection compared to a larger gauge needle. Studies have also shown smaller gauge needle to cause less pain. The aim of the study was to quantify the difference between a 22-gauge needle and 25-gauge needle during lumbosacral transforaminal epidural steroid injection in regards to intravascular uptake and pain perception. Methods: This was a prospective single blind randomized clinical trial performed at outpatient spine practice locations of two academic institutions. One hundred sixty-two consecutive patients undergoing lumbosacral transforaminal epidural injections from February 2018 to June 2019 were recruited and randomized to each arm of the study – 84 patients were randomized to the 22-gauge needle arm and 78 patients to 25-gauge arm. Each transforaminal injection level was considered a separate incidence, hence total number of incidence was 249 (136 in 22-gauge arm and 113 in 25-gauge arm). The primary outcome measure was intravascular uptake during live fluoroscopy and/or blood aspiration. The secondary outcome measure was patient reported pain during the procedure on the numerical rating scale. Results: Fisher exact test was used to detect differences between 2 groups in regards to intravascular uptake and paired t-tests were used to detect differences in pain scores. The incidence of intravascular uptake for a 22-gauge needle was 5.9% (95% confidence interval: 1.9 to 9.8%) and for a 25-gauge needle, 7.1% (95% confidence interval: 2.4 to 11.8%) [p = 0.701]. Average numerical rating scale scores during the initial needle entry for 22-gauge and 25-gauge needle was 3.46 (95% confidence interval: 2.94 to 3.98) and 3.13 (95% confidence interval: 2.57 to 3.69) respectively [p = 0.375]. Conclusions: The study showed no statistically significant difference in intravascular uptake or pain perception between a 22-gauge needle and 25-gauge needle during lumbosacral transforaminal epidural steroid injections. Trial registration: ClinicalTrials.gov NCT04350307. Registered 4/17/2020. (Retrospectively registered).
- Subjects
PAIN &; psychology; ACADEMIC medical centers; CONFIDENCE intervals; FISHER exact test; FLUOROSCOPY; OUTPATIENT services in hospitals; HYPODERMIC needles; LONGITUDINAL method; LUMBAR vertebrae; STATISTICAL sampling; SELF-evaluation; STEROIDS; T-test (Statistics); PAIN measurement; RANDOMIZED controlled trials; DESCRIPTIVE statistics; EPIDURAL injections; ADULTS
- Publication
BMC Anesthesiology, 2020, Vol 20, Issue 1, pN.PAG
- ISSN
1471-2253
- Publication type
Article
- DOI
10.1186/s12871-020-01137-0