Korean J Pain.  2019 Jan;32(1):39-46. 10.3344/kjp.2019.32.1.39.

Effect of needle type on intravascular injection in transforaminal epidural injection: a meta-analysis

• Kim JY
• Kim SN
• Park C
• Lim HY
• Kim JH

• KMID: 2430762
• DOI: http://doi.org/10.3344/kjp.2019.32.1.39

Abstract

BACKGROUND
Lumbosacral transforaminal epidural injection (TFEI) is an effective treatment for spinal disease. However, TFEI may have several types of complications, some of which can be attributed to intravascular injection. We reviewed studies to compare the intravascular injection rate among different needle types.
METHODS
We searched the literature for articles on the intravascular injection rate among different needle types used in TFEI. The search was performed using PubMed, MEDLINE, the Cochrane Library, EMBASE, and Web of Science.
RESULTS
A total of six studies comprising 2359 patients were identified. Compared with the Quincke needle, the Whitacre needle reduced the intravascular injection rate (OR = 0.57, 95% CI = [0.44-0.73], P < 0.001). However, compared with the Quincke needle, the Chiba needle did not reduce the intravascular injection rate (OR = 0.80, 95% CI = [0.44-1.45], P = 0.46). In one study, the intravascular injection rate using a blunt-tip needle was lower than that using a sharp needle. In another study, the Whitacre and the blunt-tip needle have similar intravascular injection rates, while, the catheter-extension needle showed a reduced intravascular injection rate.
CONCLUSIONS
This meta-analysis showed that the Whitacre needle reduced the intravascular injection rate as compared with the Quincke needle, but failed to establish that the Chiba needle can decrease the intravascular injection rate in TFEI. Moreover, the blunt-tip needle can reduce the intravascular injection rate compared with the Quincke needle, and the catheter-extension needle can reduce the intravascular injection rate compared with the Whitacre and the blunt-tip needle.

Keyword

Complication; Epidural anesthesia; Epidural injection; Human; Injection; Meta-analysis; Needle; Spinal diseases; Transforaminal injection

MeSH Terms

Anesthesia, Epidural
Humans
Injections, Epidural*
Needles*
Spinal Diseases

Figure

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  Fig. 1 Flow diagram of the search and selection criteria.

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  Fig. 2 Forest plot showing the odds ratio and 95% CI of intravascular injection rate in transforaminal epidural injection. (A) 25 G Whitacre needle vs. Quincke needle (B) 25 G Chiba needle vs. 25 G Quincke needle.

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