Comparison of the incidence of intravascular injection using the Tuohy and Quincke needles during ultrasound-guided caudal epidural block: a prospective randomized controlled study

Abstract

IntroductionIntravascular injection of a local anesthetic can lead to life-threatening complications, such as deficits in neurological function after caudal epidural block. This study aimed to determine whether the intravascular injection rate of the Tuohy needle is lower than that of the Quincke needle during an ultrasound-guided caudal block.MethodsTwo-hundred and thirty patients were randomized into the Quincke (n=115) and the Tuohy (n=115) needle groups. The randomly selected needle was introduced at a 45° angle until it penetrated the sacrococcygeal ligament under ultrasound guidance, and intravenous injections were analyzed using contrast-dyed digital subtraction angiography. The relationship between the incidence of intravascular injection and independent variables, including needle type, patient demographics, history of lumbosacral surgery, use of anticoagulants, anatomic variables of the sacrum, presence of bony contact during the procedure, and the number of needle repositioning under ultrasound guidance, were examined.ResultsIntravascular uptake of contrast medium was surveyed in 25/230 (10.9%) caudal blocks using digital subtraction angiography (DSA). The incidence of intravascular uptake was 13.9% (16/115) using the Quincke needle and 7.8% (9/115) using the Tuohy needle (p=0.14). Although the needle tip type was not associated with the rate of intravascular injection, the occurrence of bony contact during the procedure demonstrated a relationship with the intravenous injection (p<0.01).ConclusionsThe overall incidence of inadvertent intravascular injections during ultrasound-guided caudal block confirmed using DSA was 10.9%. Tuohy needles did not reduce intravascular injection rates during the ultrasound-guided caudal block.Trial registration numberNCT05504590.

The pros and cons of ultrasound-guided procedures in pain medicine

“…Considering the limitation of US during the caudal epidural injection, the needle tip location could not be precisely identified since it is advanced to the sacral hiatus after the sacrococcygeal ligament. Moreover, intravascular injections during the procedure could not be detected, which may occur in 10.9% of caudal blocks using digital subtraction angiography [ 31 ]. Therefore, the US-guided caudal epidural injection would be designated in category 3, showing the feasibility of US in conjunction with FL confirmation as suggested in a study (N = 120) by Park et al [ 32 ].…”