• Ji Hee Hong, Ki Beom Park, and Sung Won Jung.
• Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea.
• Pain Physician. 2022 May 1; 25 (3): 305-312.

BackgroundInadvertent intravascular injection of local anesthetics can lead to false negative results following a lumbar medial branch block (MBB) performed to diagnose facet joint origin pain. A previous study demonstrated that the type of needle could affect the incidence of intravascular injection rates.ObjectivesThe primary endpoint of this study was to compare the incidence of intravascular injection during lumbar MBB between the Quincke and Touhy needles. The secondary endpoint of this study was to compare the injection time, radiation dose, and patient discomfort during lumbar MBB between the needle types.Study DesignProspective randomized trial.SettingAn interventional pain management practice in South Korea.MethodsThe incidence of intravascular uptake of contrast medium was compared using the Touhy and Quincke needles under real-time fluoroscopy during lumbar MBB. Injection time, radiation dose, and patient discomfort during lumbar MBB were also compared.ResultsThe incidence of intravascular injection was 21.8% (21/102) in the Touhy needle group and 21.2% (22/99) in the Quincke needle group. The odds ratio for the association between the needle types and intravascular injection was 1.1. The injection time, radiation dose, and patient discomfort during lumbar MBB were similar between the Touhy and Quincke needle groups.LimitationsThis study was performed from L2 to L4 MBB of the unilateral lumbar region. Although the type of needle assigned to the patient was randomized, 3 needles, which are used for 3 levels of MBB, were identical.ConclusionsThe overall incidence rate of intravascular injection during lumbar MBB was nearly 20% under real-time fluoroscopy for both types of needle. Use of the Touhy needle did not reduce the intravascular injection rate nor the injection time, radiation dose, and patient discomfort.

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