• Young Joo, Yong Chul Kim, Sang Chul Lee, Hye Young Kim, Keun Suk Park, Eun Joo Choi, and Jee Youn Moon.
• From the *Department of Anesthesiology and Pain Medicine, Samsung Medical Center College of Medicine; †Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, Seoul; ‡Department of Anesthesiology and Pain Medicine, Chonnam National University Hospital College of Medicine, Gwangju; and §Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital College of Medicine, Gyeonggi, Republic of Korea.
• Reg Anesth Pain Med. 2016 May 1; 41 (3): 392-7.

Background And ObjectivesIntravascular (IV) injection of local anesthetics is a potential cause of false-negative results after lumbar medial branch nerve blockade (L-MBB) performed to diagnose facetogenic back pain. The aim of the present study was to identify the relationship between the needle type and the incidence of IV injection in patients undergoing L-MBB using fluoroscopy with digital subtraction imaging (DSI).MethodsIn this prospective randomized study, we compared the incidence of IV uptake of contrast medium using the Quincke needle and Whitacre needle under real-time DSI during L-MBB. Clinical and demographic factors associated with the occurrence of IV uptake were also investigated.ResultsIn total, 126 patients were randomized into the Quincke needle group (n = 62) and Whitacre needle group (n = 64). Intravascular uptake of contrast medium was observed in 66 (9.8%) of 671 L-MBB procedures under DSI. The incidence of IV uptake was 13.9% (47/338) using the Quincke needle and 5.7% (19/333) using the Whitacre needle. In the multivariate generalized estimating equations analysis, use of a Quincke needle was related to positive IV injection at a 1.898-fold higher rate than was use of a Whitacre needle (95% confidence interval, 1.025-3.516) and a positive aspiration test predicted IV injection at a 21.735-fold higher rate (95% confidence interval, 11.996-52.258).ConclusionsLumbar medial branch nerve blockade using the Quincke needle was associated with a 1.9-fold higher rate of IV injection than was L-MBB using the Whitacre needle under DSI. Although further study is needed to confirm the clinical efficacy, Whitacre needles can be considered to reduce the risk of IV injection during L-MBB.

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