Single Insertion for Multiple Injections: a Safer and Less Painful Technique for Concomitant Facet Joint and Transforaminal

Objective

To examine the effects of a novel injection technique on procedure time, radiation exposure, anesthetic use, and intraprocedure pain. Design: Prospective randomized controlled study. Setting: University spine clinic. Participants: 8 patients scheduled for symmetric bilateral lumbar facet joint and adjacent transforaminal epidural steroid injections. Interventions: Participants received injections by a “traditional” technique on 1 side, and a single needle for multiple injections (SIMI) technique on the contralateral side. All were blinded to the technique. Traditional technique involves needles placed independently for each injection, beginning with the epidural injection and ending with the facet injection. SIMI technique uses a single needle and a single insertion site to first perform the epidural injection, then withdraw and redirect the needle to the ipsilateral facet after adjusting the c-arm to a favorable view. One nonblinded physician (>5y experience) performed every injection. Injections started on the right, alternating between traditional and SIMI technique to begin. Main Outcome Measures: An independent third party recorded procedure time, fluoroscopy time, and needles used. The treating physician recorded volume of local anesthetic and intraprocedure pain on a 10-point verbal analog scale (VAS). Results: The SIMI technique reduced procedure time by 25% (mean, 148±42s vs 207±89s; P<.05) and fluoroscopy time by 37% (14.6±3.3s vs 23.1±11.8s; P<.05). The SIMI technique used 33% less local anesthetic (mean, 1.0±0.3mL vs 1.6±0.3mL; P<.01) and half as many needles (P<.01). Last, VAS scores were lower for the SIMI technique (mean, 5.9±1.9 vs 7.6±2.7; P>.05). Conclusions: The SIMI technique was less painful and safer than traditional techniques when performing concomitant facet joint and transforaminal epidural injections.