• Ji Hee Hong, Ji Hoon Park, Seung Hoon Shin, and Jae Yoon Lee.
• Keimyung University DongSan Hospital Department of Anesthesiology and Pain Medicine, Dalseo-gu, Daegu, Korea.
• Pain Physician. 2022 Oct 1; 25 (7): E969E975E969-E975.

BackgroundInadvertent intravascular injection of local anesthetics can lead to false-negative results following lumbar medial branch block (MBB) performed to diagnose facet joint origin pain. A previous study demonstrated that the type of approach method could affect the incidence of intravascular injections and technical ease of the procedure.ObjectivesThe primary objective of our study was to compare the incidence of inadvertent intravascular injection and technical ease of the MBB between anteroposterior (AP) and oblique (OB) views.Study DesignProspective randomized trial.SettingAn interventional pain management practice in South Korea.MethodsThe incidence of intravascular uptake of contrast medium was compared using AP and OB fluoroscopic views during lumbar MBB. Injection time, radiation dose, and patient discomfort during lumbar MBB were also compared. Risk factors associated with a longer procedure time and a higher radiation dose were analyzed.ResultsThe incidence of intravascular injection was 22.5% (23/102) in the AP group and 17.6% (18/102) in the OB group (P = 0.382). A significantly longer injection time and a higher dose of radiation were required to complete 3 levels of MBB in the OB group than in the AP group (45.9 seconds vs 61.9 seconds, P = 0.001; 27.4 centigray [cGy]/cm2 vs 42.2 cGy/cm2, I = 0.004). The OB approach and left side injection were the risk factors associated with a longer total procedure time (odds ratio [OR] = 6.64, 95% CI, 1.99-22.17, P = 0.002; OR = 0.20, 95% CI, 0.06-0.67, P = 0.009, OB and AP, respectively).LimitationsThe physician performing the MBB could recognize the AP or OB fluoroscopic view during procedure.ConclusionThe overall incidence rate of intravascular injection during lumbar MBB showed nearly 20% in both approach methods groups. The OB approach and left side MBBs were associated with a longer total procedure time and a higher radiation dose.

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