Influence of an ultrasound-guided catheter-over-needle technique on the incidence of intravascular injection during caudal epidural injections: a prospective, randomized clinical trial.

AIM: Caudal epidural injection is used for lumbosacral radicular pain but there is a risk of vascular injection. An ultrasound-guided catheter-over-needle technique was proposed to reduce this risk. This study compared the incidence of vascular injections between the catheter-over-needle and Tuohy needle methods for caudal epidural injections.

MATERIAL AND

METHODS

This prospective, randomized clinical trial included patients aged ≥19 years with degenerative lumbar disease accompanied by radicular pain who were unresponsive to non-invasive treatments and scheduled for caudal epidural injection. The participants were randomized into two groups: catheter-over-needle and Tuohy needle groups. Under ultrasound guidance, the contrast medium was injected and observed in real time using fluoroscopy. An independent physician assessed the vascular injection rates.

RESULTS

The incidence of vascular injection was significantly lower in the catheter-over-needle group (15.7%) than in the Tuohy needle group (37.5%; p=0.014). Chronic pain lasting >12 months was a significant risk factor for vascular injection (p=0.035). However, no statistically significant association was found between sacral opening depth and vascular injection, although the sacral opening depth was shorter in patients who received intravascular injections.

CONCLUSIONS

The catheter-over-needle technique significantly reduces the risk of vascular injection. The depth of the sacral opening may also influence vascular injection.