900 - 27-Gauge Needles in Caudal Epidural Steroid Injections: Enhanced Comfort, Safety, and Efficacy in Pain Management

Case Diagnosis: Radicular Pain due to L5-S1 Lumbar Disc Degeneration

Case Description: A 62-year-old female with severe chronic lower back pain due to L5-S1 degenerative disc disease presented for Caudal Epidural Steroid Injection. Seeking a less painful alternative to traditional 18-25G needles, a 27G needle was used, providing comparable relief with reduced periprocedural discomfort.
In the prone position, the sacral hiatus was identified under fluoroscopic guidance. Following skin preparation, local anesthetic was administered through a 27G 1.5-inch needle inserted at a 45-degree angle and advanced into the sacrococcygeal ligament and caudal epidural space. Placement was confirmed with contrast fluoroscopy, demonstrating effective epidural spread. The corticosteroid solution was injected smoothly with slight resistance and no complications.

Discussions: The single 27G needle achieved epidurogram patterns and pain relief outcomes similar to traditional 18-25G 3.5-inch needles. This technique, serving as both a localization and therapeutic tool, eliminates the need for a second needle, reducing procedural steps and potential microbial exposure in a high risk area.
The patient reported minimal discomfort due to the finer needle diameter. Post-procedural pain and bruising were negligible, improving patient acceptance and reducing procedural anxiety. Concerns about increased resistance were unfounded, as medication flow remained controlled and effective. The smaller gauge also allowed easier navigation through narrow tissue, which especially benefits female patients with higher pain sensitivity and smaller sacral hiatuses. Additionally, this approach can reduce material costs, easing financial burden and improving treatment access and adherence, which disproportionately affect underserved populations. To our knowledge, this is the first documented case highlighting successful caudal epidural steroid injection using a 27G needle.

Conclusions: This case underscores the efficacy and comfort provided by 27G needles in Caudal Epidural Steroid Injection. The streamlined single-needle approach offers a cost effective, safer, and comparably effective alternative for patients, promoting broader acceptance and satisfaction.