Background: Inadvertent intravascular injection has been suggested as the most probable mechanism behind serious\nneurological complications during transforaminal epidural steroid injections. Authors believe a smaller gauge needle may\nlead to less intravascular uptake and less pain. Theoretically, there is less chance for a smaller gauge needle to encounter\na blood vessel during an injection compared to a larger gauge needle. Studies have also shown smaller gauge needle to\ncause less pain. The aim of the study was to quantify the difference between a 22-gauge needle and 25-gauge needle\nduring lumbosacral transforaminal epidural steroid injection in regards to intravascular uptake and pain perception.\nMethods: This was a prospective single blind randomized clinical trial performed at outpatient spine practice locations of\ntwo academic institutions. One hundred sixty-two consecutive patients undergoing lumbosacral transforaminal epidural\ninjections from February 2018 to June 2019 were recruited and randomized to each arm of the study â?? 84 patients were\nrandomized to the 22-gauge needle arm and 78 patients to 25-gauge arm. Each transforaminal injection level was\nconsidered a separate incidence, hence total number of incidence was 249 (136 in 22-gauge arm and 113 in 25-gauge\narm). The primary outcome measure was intravascular uptake during live fluoroscopy and/or blood aspiration. The\nsecondary outcome measure was patient reported pain during the procedure on the numerical rating scale.\nResults: Fisher exact test was used to detect differences between 2 groups in regards to intravascular uptake and paired\nt-tests were used to detect differences in pain scores............................
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