title: Impact of Type of Needle on Incidence of Intravascular Injection During Diagnostic Lumbar Medial Branch Block.
abstract: OBJECTIVE
  Intravascular (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).
  
  
  METHODS
  In 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.
  
  
  RESULTS
  In 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).
  
  
  CONCLUSIONS
  Lumbar 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.
authors.affiliation: 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.
authors.forename: Young
authors.initials: Y
authors.lastname: Joo
authors.forename: Yong Chul
authors.initials: YC
authors.lastname: Kim
authors.forename: Sang Chul
authors.initials: SC
authors.lastname: Lee
authors.forename: Hye Young
authors.initials: HY
authors.lastname: Kim
authors.forename: Keun Suk
authors.initials: KS
authors.lastname: Park
authors.forename: Eun Joo
authors.initials: EJ
authors.lastname: Choi
authors.forename: Jee Youn
authors.initials: JY
authors.lastname: Moon
mesh_terms: D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D015901:Angiography, Digital Subtraction; D003287:Contrast Media / Q000008:administration & dosage*; D004867:Equipment Design; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007275:Injections, Intravenous; D007278:Injections, Spinal; D007479:Iopamidol / Q000008:administration & dosage*; D017116:Low Back Pain / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D008875:Middle Aged; D015999:Multivariate Analysis; D009339:Needles; D009407:Nerve Block / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015641:Radiography, Interventional; D056910:Republic of Korea; D012307:Risk Factors; D021801:Zygapophyseal Joint / Q000294:innervation*
chemical_list: D000779:Anesthetics, Local; D003287:Contrast Media; D007479:Iopamidol