2021년도 제71차 대한통증학회 학술대회 및 연수교육

Background
Transforaminal epidural injection (TFEI) is widely used in clinical practice to effectively deliver therapeutic drugs to the ventral epidural space. Because the Adamkiewicz artery and other vessels are located in the tragectory, intravascular injection may occur, which may cause spinal cord infarction, epidural hematoma, paraplegia, etc. Therefore, it is important to select a needle for safety. Tuohy needles are widely used for epidural blocks, this type of needle has not been studied for TFEI. So, the purpose of our study is to compare Touhy needle and Quincke needle in intravascular injection during TFEI.

Method
Two hundred four TFEI cases were randomly assigned to one of two needle groups (22-gauge Quincke needle or 22-gauge Tuohy needle). Intravascular injection was evaluated using digital subtraction angiography. The ventral and medial epidural space spread was confirmed by the diffusion of the contrast medium. Also, we measured the procedure time between the two needle groups.

Results
The overall incidence of intravascular injection was 7.8%. The rate of intravascular injection was significantly lower in the Tuohy needle group than the Quincke needle group (2.9% vs. 12.7%, p=0.009). The ventral and medial epidural spread rates of the Tuohy needle group were 92.2% and 95.1%, respectively, significantly higher than those of the Quincke needle group. The procedure time was shorter in the Tuohy needle group than in the Quincke needle group (97.4±19.3) seconds vs. 117.8±31.9) seconds, p=0.005).

Conclusion
In conclusion, Tuohy needles had a lower intravascular injection rate and higher medial and ventral epidural spreading rates than Quincke needles. In addition, the procedure time was significantly shorter in the Touhy needle group.