How do you bend your needles?

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Ligament

Interventional Pain Management
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IF you bend your needle tips, which way do you bend your needle tip and why? I will put a 5-10degree bend a couple centimeters proximal to the tip to enhance the action of the bevel, ie I bend away from the hub notch.

I've seen others I respect bend toward the hub notch.

Are there any articles on this issue? I believe there was one recently in the ISIS journal but I cannot find it online.

best.

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Depends on what you are trying to accomplish....
With 22ga needles I use a last 1cm tip bend with a hemostat. For transforaminal lumbar blocks, usually a 10 deg bend will do. For z-joint injections lumbar 10 deg, thoracic z-joints I use 20deg, and around 15 for cervical IA z-joint injections, although I usually do medial branch blocks instead. For lumbar discography, I use 20 deg for L3-4 and L4-5, up to 45 deg for L5-S1, and 10 deg for L1-2 and L2-3. Cervical discography 10 deg. For caudal epidurals I use a 20 deg bend over the last 2 cm except for the morbidly obese, in which I may use up to a 40 deg bend over the last 1cm. For transcaudal lateral recess blocks at L5S1, I use a double curve of 20 deg at the tip and another 10-15 deg over the distal 10cm of the blunt 203mm needle in order to keep the tip in the anterior epidural space. For far lateral approach transforaminal epidural and lateral recess blocks, I use a 20 deg curve at the tip and a straight shaft for the 20 ga blunt needles. For an interlaminar approach lateral recess block, I use a 20 deg curve at the blunt needle tip and approach from the contralateral side entering the ligamentum flavum on just to the contralateral side of the needle entry or alternatively use a 22ga spinal needle with a 30 deg angle at the tip to target the most medial border of the lamina at the disc level, then walk under the lamina and laterally. RF, I use 15deg curves at the tip..
All curves are with the bevel, to accentuate the natural curve the needle would take due to the bevel inclination.
It is rare for me to use a straight needle....
 
during residency I trained curving away from the notch or bevel. During fellowship we are curvin towards the bevel. The degree seems to vary by the attending.
 
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Do not try to bend the needle; that's impossible. Instead, only try to realize the truth. There is no needle. Then you'll see that it is not the needle that bends, it is only yourself.
 

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Well, I trained in residency bending away from the notch, tend to find this to be my preferred method. Makes a 25ga needle drive like a Porshe. Others I respect bend toward the notch, so I'm trying to keep an open mind to it until I get more experience.

Interestingly, Fenton's book recommends NOT bending the tip, citing increased tissue damage as the reason. However, I find I need much fewer insertion/retraction passes of the needle with a bent tip, therefore I think the tissue damage overall is the same or less.

I tend to "drive" the needle with simply rotating the hub, and rarely need to bow the shaft, when using a bent tip.

This discussion must sound terribly boring to Algos and Gorback!

which way do you prefer?
 
I bend the needle towards the bevel( to the side the marker on the stylette and I do this by inserting the needle into an 18 guage blunt needle to make a smooth bend 0f 20 degrees.

The science is the needle always goes towards the tip( opposite to bevel) and ideally you should bend towards the tip even though I dont do this so that the bend and the tip make it curve in the same direction🙂
 
zzzzzzzzzzzzzzzzzzzzzzzzzz.

I just place the needle tip bevel down on something hard like the side of a clamp or the steel plate in my head and press on it with my finger. I don't have a sterile protractor to measure the angle, but I'd guess somewhere around 0.2-0.4 radians. For discography I use the sine of the c-arm angle divided by the cotangent of the latitude, times pi. Below the equator you have to reverse that. Try to have the bend about 0.00004 furlongs from the tip.

If you have the bevel on the outer surface of the bend it will steer better because of the flat surface, which deflects more than a rounded surface. Then you can do this:

http://www.angelfire.com/planet/painkillah/pain_pictures/index.album?i=10&s=1

Tips and tricks of the Ancient Zen Pain Doctors: Sometimes it's hard to get the stylet out of a curved needle. Then you have to really pull on it and you end up jerking the needle out of position. If your hand jerks during a TF you could end up advancing it into something you'd wish you hadn't. So take out the stylet before you get to your final destination if there are delicate things nearby.
 
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