Background: Cervical transforaminal epidural block (CTEB) is a useful option in the
diagnosis and treatment of cervical radicular pain. However, inadvertent intravascular
injection can lead to severe neurologic complications. Blunt needles are considered to
displace instead of penetrate vessels because of their dull needle tip.
Objectives: To investigate whether there is a difference between blunt and sharp needles
in intravascular injection rates during CTEB.
Study Design: Prospective, randomized, clinical trial.
Setting: A tertiary hospital in South Korea.
Methods: After institutional review board approval, 108 patients undergoing CTEB for
treatment of radicular pain resulting from spinal stenosis and herniated nucleus pulposus
were randomly assigned to one of 2 needle groups (blunt needle or sharp needle). The
needle position was confirmed using biplanar fluoroscopy, and 2 mL of nonionic contrast
medium was injected to detect intravascular injection. Intravascular injection was defined as
the contrast medium spreading out through the vascular channel during injection under realtime fluoroscopy. This study was registered in ClinicalTrials.gov.
Results: The intravascular injection rate was not significantly different between the blunt
needle and sharp needle groups (35.2% vs. 33.3%, P > 0.05). The procedure time was
longer in the blunt needle group than in the sharp needle group (101.00 ± 12.4 seconds vs.
56.67 ± 8.3 seconds, P < 0.001).
Limitations: This was a single-center study. Additionally, the physicians could not be
blinded to the type of needle used.
Conclusions: In the present study, use of a blunt needle did not reduce the rate of
intravascular injection during CTEB compared to use of a sharp needle. In addition, procedure
time significantly increased with blunt needle use compared to sharp needle use.
Key words: Analgesia, bleeding, blunt needle, cervical spine, clinical trials, complications,
intravascular injection, radiculopathy, sharp needle, transforaminal epidural block
09 / The difference of intravascular injection rate during cervical transforaminal epidural block using blunt needle compared to sharp needle.
