• Matthew Smuck, Stephen Paulus, Ajay Patel, Ryan Demirjian, Ma Agnes Ith, and David J Kennedy.
• Department of Orthopaedic Surgery, Stanford University, Redwood City, California.
• Pain Med. 2015 Nov 1; 16 (11): 2084-9.

ObjectiveTo quantify the incidence of inadvertent vascular penetration during lumbosacral transforaminal epidural injections using blunt-tip, pencil-point, and catheter-extension needles.Study Design/SettingThis is a prospective, observational, consecutive cohort study.SubjectsTwo hundred consecutive patients undergoing lumbosacral transforaminal epidural injections at an academic outpatient spine center.MethodsFour hundred seventy-five fluoroscopically guided lumbosacral transforaminal epidural injections were performed on consecutively consenting patients by one interventional spine physician, using three different needle types. The presence or absence of vascular uptake was determined during contrast injection under live fluoroscopy.ResultsVascular uptake of contrast was observed in 58 of the total 475 injections, for an overall incidence of 12.2%. By needle type, the incidence of inadvertent vascular uptake was 16.6% (26/157) in the pencil-point group, 15.6% (24/154) in the blunt-tip group, and 4.9% (8/164) in the catheter-extension group. The difference in rates is statistically significant between the catheter-extension needle group and both the pencil-point group (P = 0.0009) and blunt-tip group (P = 0.0024). A secondary analysis was performed to quantify the incidence of functional pitfalls between needle groups, with a significantly lower incidence in the pencil-point group compared to both the catheter-extension (P = 0.0148) and blunt-tip needle (P = 0.0288) groups.ConclusionsBlunt-tip and pencil-point needles have comparable risk of inadvertent vascular injection during lumbosacral transforaminal injections. Catheter-extension needles demonstrated a reduce incidence of vascular uptake, but also result in a significantly higher rate of functional pitfalls that limits their usefulness in routine practice.Wiley Periodicals, Inc.

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