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A blunt needle (Epimed(®)) does not eliminate the risk of vascular penetration during transforaminal epidural injection

BACKGROUND: Transforaminal epidural injection of local anesthetics and corticosteroids is a common practice in patients with radicular pain. However, serious morbidity has also been reported, which can be attributed to an arterial or venous injection of the medication especially particulate glucocor...

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Autores principales: Ilkhchoui, Yashar, Koshkin, Eugene
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3841942/
https://www.ncbi.nlm.nih.gov/pubmed/24340239
http://dx.doi.org/10.4103/2152-7806.120784
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author Ilkhchoui, Yashar
Koshkin, Eugene
author_facet Ilkhchoui, Yashar
Koshkin, Eugene
author_sort Ilkhchoui, Yashar
collection PubMed
description BACKGROUND: Transforaminal epidural injection of local anesthetics and corticosteroids is a common practice in patients with radicular pain. However, serious morbidity has also been reported, which can be attributed to an arterial or venous injection of the medication especially particulate glucocorticoid preparations. Using a blunt needle in contrast to sharp needle has been suggested to reduce this risk in a study on animals. CASE DESCRIPTION: We present a 59-year-old female with L5 lumbar radicular symptoms and left L5-S1 foraminal narrowing who underwent transforaminal epidural injection with fluoroscopic guidance using a 22-gauge blunt curved needle (Epimed(®), Johnstown, NY). Intravascular needle placement was detected during real-time contrast injection under live fluoroscopy after a negative aspiration and local anesthetic test dose. The needle was slightly withdrawn and correct distribution of the contrast was confirmed along the target nerve root and into the epidural space. CONCLUSION: This case report discusses vascular penetration utilizing an Epimed(®) blunt needle to perform transforaminal injections in a clinical setting. This topic was previously discussed in earlier animal studies. We also reemphasize that neither negative aspiration or local anesthetic test doses are reliable techniques to ensure the safety of transforaminal epidural injections.
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spelling pubmed-38419422013-12-11 A blunt needle (Epimed(®)) does not eliminate the risk of vascular penetration during transforaminal epidural injection Ilkhchoui, Yashar Koshkin, Eugene Surg Neurol Int Surgical Neurology International: Spine BACKGROUND: Transforaminal epidural injection of local anesthetics and corticosteroids is a common practice in patients with radicular pain. However, serious morbidity has also been reported, which can be attributed to an arterial or venous injection of the medication especially particulate glucocorticoid preparations. Using a blunt needle in contrast to sharp needle has been suggested to reduce this risk in a study on animals. CASE DESCRIPTION: We present a 59-year-old female with L5 lumbar radicular symptoms and left L5-S1 foraminal narrowing who underwent transforaminal epidural injection with fluoroscopic guidance using a 22-gauge blunt curved needle (Epimed(®), Johnstown, NY). Intravascular needle placement was detected during real-time contrast injection under live fluoroscopy after a negative aspiration and local anesthetic test dose. The needle was slightly withdrawn and correct distribution of the contrast was confirmed along the target nerve root and into the epidural space. CONCLUSION: This case report discusses vascular penetration utilizing an Epimed(®) blunt needle to perform transforaminal injections in a clinical setting. This topic was previously discussed in earlier animal studies. We also reemphasize that neither negative aspiration or local anesthetic test doses are reliable techniques to ensure the safety of transforaminal epidural injections. Medknow Publications & Media Pvt Ltd 2013-10-29 /pmc/articles/PMC3841942/ /pubmed/24340239 http://dx.doi.org/10.4103/2152-7806.120784 Text en Copyright: © 2013 Ilkhchoui Y. http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Surgical Neurology International: Spine
Ilkhchoui, Yashar
Koshkin, Eugene
A blunt needle (Epimed(®)) does not eliminate the risk of vascular penetration during transforaminal epidural injection
title A blunt needle (Epimed(®)) does not eliminate the risk of vascular penetration during transforaminal epidural injection
title_full A blunt needle (Epimed(®)) does not eliminate the risk of vascular penetration during transforaminal epidural injection
title_fullStr A blunt needle (Epimed(®)) does not eliminate the risk of vascular penetration during transforaminal epidural injection
title_full_unstemmed A blunt needle (Epimed(®)) does not eliminate the risk of vascular penetration during transforaminal epidural injection
title_short A blunt needle (Epimed(®)) does not eliminate the risk of vascular penetration during transforaminal epidural injection
title_sort blunt needle (epimed(®)) does not eliminate the risk of vascular penetration during transforaminal epidural injection
topic Surgical Neurology International: Spine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3841942/
https://www.ncbi.nlm.nih.gov/pubmed/24340239
http://dx.doi.org/10.4103/2152-7806.120784
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