steering 25g needles

[DoYouEvenLiftBro]

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Lumbar skin wheal with bicarb, 25g, 3.5in can usually hit all 3 unilateral mbbs from that one site
If issues steering it, you can try pulling on skin, or over accentuating the curve of the needle when it’s in there as well
Agree with corkscrew, and just rotating 180 back and forth

 

[Ducttape]

Put some alcohol in the refrigerator. Kill two birds with one stone. Problem solved.

not a good idea.

staff tend to drink it...

unless you are planning on killing your MAs. then go for it.

 

[RoloTomassi]

Downside of redirecting technique is 3x radiation

 

[DoYouEvenLiftBro]

Downside of redirecting technique is 3x radiation

Low dose and pulse still under 20 seconds total fluoro

Saves on overhead just 1 needle too

 

[ED50]

I use 30 gauge for all mbb with tiny skin wheel. 25g 1.5 in needle for esi,si etc to numb the track. I mostly use 25g for all my injections, but I'm interested in trying a 23g to see how it steers. I tried a few injections without local and the patients definitely jumped more with me so back to local.

 

[Ferrismonk]

I've found the pain/gauge scale flips below a 22g. So I don't use local for 22g/25g, but will for 20g/18g. Most everything I do is with a 25g.

Most of my patients jump a lot more from my room-temp betadine than they do for my needles.

 

[epidural man]

For those out there that love their 25g spinals.... how? I find that regardless of whether I bend the tip or keep it straight, I very frequently have my needle flopping around like a piece of spaghetti when I'm trying to do an MBB with them. When my initial placement is perfect and I can essentially dive entirely coaxial to target, it's fine. Otherwise I have a very hard time making it go where I want to go. When I switch to a 22g, I have no problems hitting the bullseye.

I want to like the 25g because I'm sure it's theoretically less painful for patients, but at this point, using no local with a noodle 25g fishing around for a target has seemed consistently much less comfortable than local plus 22g.

I bet if someone studied the patient experience comparing 25g to 22g with no local, it would be the same.

for lumbar mbb, I use local for 22g. If I am teaching a resident or fellow in first 6 months, 22g all day long.

just me- I use a straight 25g (no bend). The trick is having the en-fac view BEFORE entering the muscle. After you get in the muscle, the ability to steer that thing goes way down.

 

[Ducttape]

studies are all over the place.

on one side:

Differential rates of intravascular uptake and pain perception during lumbosacral epidural injection among adults using a 22-gauge needle versus 25-gauge needle: a randomized clinical trial - PubMed

ClinicalTrials.gov NCT04350307. Registered 4/17/2020. (Retrospectively registered).

pubmed.ncbi.nlm.nih.gov

ABG needle study: a randomised control study comparing 23G versus 25G needle success and pain scores - PubMed

ACTRN12609000957291.

pubmed.ncbi.nlm.nih.gov

on the other:

The importance of needle gauge for pain during injection of lidocaine - PubMed

A significant preponderance of respondents stated that there had been less pain using the thinnest needle. Mean VAS responses showed the same trend, but the differences between them were not statistically significant.

pubmed.ncbi.nlm.nih.gov

The use of a fine-gauge needle to reduce pain in open carpal tunnel decompression: a randomized controlled trial - PubMed

This randomized controlled study on 86 patients compared the level of pain experienced by patients on instillation of local anaesthetic into the palm with a 23-gauge and a 27-gauge (dental) needle in open carpal tunnel decompression. Patients were asked to score the amount of pain they...

pubmed.ncbi.nlm.nih.gov

The effect of needle gauge and lidocaine pH on pain during intradermal injection - PubMed (of note, from 1998 and bicarb was most beneficial tho 30 was less painful than 25)