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Intravascular injection in lumbar medial branch block: a prospective evaluation of 1433 injections
Chul Joong Lee1, Yong Chul Kim, Jae Hyuck Shin
1Department of Anesthesiology and Pain Medicine, Samsung Seoul Hospital, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Background:
The successful outcome and validity of lumbar medial branch block (MBB) are largely dependent on technique accuracy. Intravascular uptake of injectate causes a false-negative response to block and is associated with various possible complications. In the current study, we prospectively evaluated the incidence of, and the factors associated with, intravascular injection during block. In addition, we assessed the efficiencies of generally accepted safety measures, such as preinjection aspiration and intermittent fluoroscopy to avoid intravascular injections.
Methods:
We prospectively examined 1433 lumbar MBBs in 456 patients performed by seven physicians. Aspiration test, spot radiography, and contrast injection under real-time fluoroscopic visualization were performed sequentially without repositioning the needle. Incidences of blood flashback and the presence of intravascular contrast spread on spot radiographic images and during real-time fluoroscopy were checked. The factors studied for intravascular injection included physician experience, patient age and sex, needle gauge, and block spinal level.
Results:
No specific factors were found to affect the incidence of intravascular uptake during block. The overall incidence of intravascular uptake was 6.1% per nerve block (88/1433), and 30 of these were predicted by preinjection aspiration (sensitivity = 34.1%) and 52 by spot radiography (sensitivity = 59.1%).
Conclusions:
The aspiration test with or without spot radiography frequently missed the intravascular uptake of contrast during lumbar MBBs. We strongly advocate the use of real-time fluoroscopy during contrast injection to increase diagnostic and therapeutic value and to avoid possible complications.
Insights
Real-time fluoroscopy is crucial for accurate lumbar medial branch blocks (MBB), as pre-injection aspiration and spot radiography often miss intravascular injections, which can lead to complications.
Area of Science:
- Pain Management
- Interventional Radiology
- Anesthesiology
Background:
- Accurate technique is vital for lumbar medial branch block (MBB) success.
- Intravascular uptake of injectate can cause false-negative results and complications.
- This study evaluates intravascular injection incidence and safety measure effectiveness.
Purpose of the Study:
- To determine the incidence of intravascular injection during lumbar MBB.
- To identify factors associated with intravascular injections.
- To assess the efficacy of pre-injection aspiration and intermittent fluoroscopy.
Main Methods:
- Prospective evaluation of 1433 lumbar MBBs in 456 patients.
- Sequential use of aspiration, spot radiography, and real-time fluoroscopy.
- Analysis of factors including physician experience, patient demographics, needle gauge, and spinal level.
Main Results:
- No specific factors influenced intravascular uptake incidence.
- Overall intravascular uptake occurred in 6.1% of blocks.
- Pre-injection aspiration and spot radiography had limited sensitivity (34.1% and 59.1%) in detecting intravascular uptake.
Conclusions:
- Aspiration and spot radiography frequently fail to detect intravascular contrast during lumbar MBB.
- Real-time fluoroscopy is strongly recommended for contrast injection.
- Real-time fluoroscopy enhances diagnostic/therapeutic value and prevents complications.
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