Interventional pain management involves the use of image-guided procedures as well as targeted delivery of medications to modulate pain, symptoms, and disease. To facilitate these procedures, an interventionalist has to utilize a variety of equipment, ranging from simple needles for a trigger point injections to the use of an MRI or a CT scanner for more complex procedures.
Without proper equipment, the procedures cannot be done in a reliable manner and are basically described as “blind” techniques. This chapter covers various types of needles and specialized catheters and syringes. Some major equipment such as a fluoroscopy machine is covered elsewhere in this atlas (see Chapters 1 and 4).
Although it is necessary to consider the anatomical variations in males, females, adults, and children, the basic need for most of the equipment remains the same. However, depending on the patient’s size and type of a procedure, one must consider the proper type and length of needles, anticipate difficulties, and be prepared for possible complications in case ideal equipment is not available. For example, a larger patient would need a longer needle (and choosing a shorter needle may lead to multiple or failed attempts as well as improper placement of the needle), a sharp needle instead of a pencil point needle may lead to nerve damage, a spinal needle used for epidural access would lead to higher rates of dural punctures. Without proper equipment for guidance of a needle (such as a fluoroscopy unit or an ultrasound unit), the needle may end up in an unintended location and even cause unintentional trauma to tissue.
BASIC CONCERNS AND CONTRAINDICATIONS
Based on the procedure to be performed, it is inappropriate to use certain equipment such as a long needle for a shallow procedure which can lead to higher rate of complications.
Needles (Nonepidural Placements)
Quincke needle—note the sharp tip of the needle which has a cutting edge. (Used with permission from Aakash Patel.)
Most common type of bevel seen in needles.
It is a sharp bevel that facilitates penetration of the skin.
Various needles that have such bevels are intended for intramuscular and intravenous access, biopsies, subcutaneous drug delivery, etc.
Spinal needles are mainly available with this type of bevel and are commonly used for several interventional procedures.
Pencil point (Figure 5-2)
Pencil point needle. (Used with permission from Aakash Patel.)