When Does Needle Choice Really Matter?

When does needle choice really matter?

Brachial plexus blocks!  Large monofasicular nerves are clearly at greater risk for intraneural needle tip placement.  A blunt tip block needle that is short (1-2 inches) should be used whenever possible.  There is no definitive data to guide us here, but expert opinion is clear, proximal blocks such as the interscalene brachial plexus block are relatively higher risk for needle to nerve injury and a larger bore, blunt tip needle likely improves safety.

1. We use a 22G blunt tip block needle with a small stopper to prevent deep injection (subarachnoid placement ) Popliteal Sciatic blocks.  Here the imaging can be tricky and close needle to nerve placement often necessary for a successful block. Having a blunt needle tip helps reduce risk of harm when needling very close to the nerve. In addition, there are large vessels, easily compressed and missed while scanning, increasing the risk for intravascular injection.  

2. We use a 20G Touhy needle with blunt tip to reduce risk of needle-to-nerve injury, inadvertent intrafasicular placement, and inadvertent intravascular injection. What about femoral blocks?  There is no reason to be anywhere near to the femoral nerve for this block.  Needling close to the nerve itself, versus in the sub-fascia iliaca plane adds risk without benefit.  Thus, improving block safety should be accomplished primarily by needle placement being at least 1-2cm lateral to the femoral nerve.  

3. We use a 20G Touhy needle with blunt tip to reduce risk of needle-to-nerve injury, inadvertent intrafasicular placement, and inadvertent intravascular injection.

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