Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
BACKGROUND: Interventional pain procedures involve placement of fine-gauge spinal needles, which practitioners will frequently bend to facilitate both driving the needle through tissue, and to increase accuracy of placement at a specific spinal structure or nerve target. This bend is commonly performed by hand, leaving the proceduralist at risk for fingerstick injury, and the patient at risk of site contamination. However, few case studies have been published, and there are almost no data on physician preference or practice.
OBJECTIVES: The purpose of this study was to survey interventional pain physicians on their practice of spinal needle manipulation before performing lumbar medial branch nerve blocks. Specific aims were to assess the prevalence of manual needle bending, and to determine possible associations with practitioner experience, clinical environment, and fingerstick injury.
STUDY DESIGN: A survey.
SETTING: Annual 2018 American Society for Interventional Pain Physicians conference in Orlando, Florida.
METHODS: A convenience sample of participants were screened for eligibility and asked to voluntarily participate in a de-identified IRB-approved survey (IRB201703055). The survey consisted of 5 questions, 2 with binary answer choices and the remaining 3 with multiple answer choices. Data were collected on an iPad via Qualtrics software. Data were analyzed by descriptive statistics (counts, percentages).
RESULTS: Of 480 interventional pain physician attendees at the conference, 154 (32.1%) completed the survey. The majority (114/154; 74%) reported ‘always’ bending the distal tip of spinal needles, and a further 21 (14%) reported ‘sometimes’; 19 (12%) said they do not bend their needles. Only 25 (18%) respondents used an instrument to bend their needles; 112 (82%) bend their needles by hand. Eight respondents (6%) reported a fingerstick injury while bending a spinal needle, one while using an instrument, and 7 during a manual bend. Approximately half of respondents had been practicing for greater than 15 years; 78% work in a private practice environment.
LIMITATIONS: Due to the setting, the recruitment method presents the possibility of selection bias. Furthermore, although the response rate may appear low, it is higher than similarly performed studies.
CONCLUSIONS: Spinal needle manipulation is common prior to performing interventional pain procedures, and most spinal needle manipulations are performed by hand. Rate of fingerstick injury was low in this sample, but cannot be evaluated without comparative data. Factors to be considered in a subsequent study are the effects of needle bend variability relative to practitioner experience and alternative means of needle manipulation.
KEY WORDS: Interventional pain procedures, spinal needles, facet joint injections, needle bending, fingerstick injuries