What equipment is needed to perform therapeutic injections for pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Answer

Answer

The application of therapeutic injections and regional anesthesia requires knowledge of equipment that includes needles, syringes, and catheters. The Luer lock is a conical tip that allows easy exchange of needle to syringe and is named after the person who developed it. Today, most needles are disposable, with the bevel cut in 3 planes to minimize tissue laceration and discomfort. Needles that are used for deep injection during regional block should incorporate a security bead on their shafts so that the needle can be retrieved if the needle hub separates from the shaft.

Generally, disposable straight needles with a beveled or pencil-point shaped tip are used for spinal interventional procedures. Spinal and deep injections are best accomplished with a styletted needle, which has an outer cannula through which a smaller needle or catheter can be inserted. The inner stylet seals the cannula and prevents tissue from entering the cannula as the needle is advanced. The stylet should always remain entirely within the cannula when there is forward movement of the needle. Many advocate the use of a short needle bevel to reduce neural and vascular trauma. [1] Rounded needle tips have been advocated for puncturing the dura to access the subarachnoid space.

In theory, rounded tips gently spread the dural fibers and may reduce the incidence of dural cuts that cause post spinal tap headaches. Caution must be exercised with long bevel needles because the soft metal tip is more likely to develop a hook or barb at the tip after striking a bony surface or with prolonged use during a procedure. Furthermore, needles with a smaller caliber (less than 20 gauge) or with a length greater than 3.5 inches are more difficult to steer through tissues of low resistance.


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