Search

INTRODUCTION Post-dural puncture headache (PDPH), a serious complication of spinal anesthesia (SA) may persevere for long time and can be unbearable to the patients. The incidence of PDPH unswervingly relies on the size of the spinal needles used and this gradually decreases with the use of thinner spinal needles. MATERIAL AND METHODS A prospective randomized single blinded study was conducted during the period between 1 to 29 January 2019, at Universal College of Medical Sciences, Nepal. A total of 120 patients (between 20-35 years of age) were divided into two groups: Group I: 60 patients given SA with 27-G Quincke needle and Group II: 60 patients given SA with 27-G Whitacre. Randomization was done by coin tossing method and double-blinded except for the anesthetist performing the spinal block. Patients were interviewed on days 1 to 5 and were questioned with regard to headache based on its severity, location, character, duration, associated symptoms (nausea, vomiting, auditory and ocular symptoms). The severity of the headache was analyzed by Crocker scale. RESULTS The results showed that 33% more headache in group A, but the t-value was 0.727 and p-value was 0.2345 which was statistically insignificant. CONCLUSION Hence, using 27-G Quincke spinal needles does appear to be advantageous to the patients whereas, Whitacre spinal needles are shown to be clearly associated with fewer cases of PDPH.

To identify commonly used needle types in cross-sectional interventional radiology (CSIR) and to review features and safety profiles of those needles. Members of the Society of Abdominal Radiology (SAR) emerging technologies commission (ETC) on CSIR were sent a 13-question survey about what needles they use for common CSIR procedures: random and targeted solid organ biopsy, ultrasound-guided paracentesis, and ultrasound-guided thyroid fine needle aspiration (FNA). Results were compiled with descriptive statistics, and features of the most commonly used needles were reviewed. 19 surveys were completed (response rate 57.6%, 19/33) from 16 institutions. For solid organ biopsies, the majority of respondents reported using an 18-gauge needle with an automatic firing mechanism and a variable throw length option. The most commonly used needle for both random and targeted biopsies was the Argon BioPince (26.3%, 5/19) The three most commonly used needles for solid organ biopsies all featured automatic firing, variable throw length options, and 18-gauge size. A 5 French Cook Yueh needle was most the most commonly used paracentesis needle (36.8%, 7/19). For thyroid FNA, all respondents used spinal needles, and 25-gauge was the most common size (72.2%, 13/18). Abdominal radiologists use a variety of needles when performing common interventional procedures. Members of the SAR CSIR ETC commonly use automatic, 18-gauge, variable throw length needles for solid organ biopsies, 5 French catheter style needles for paracentesis, and 25-gauge spinal needles for thyroid FNA.

Background: Real time ultrasound guided fine needle aspiration cytology (FNAC) of non-palpable, intraabdominal and intra-pelvic masses are easily performed and reported rapidly. Needle tip can be visualized and manipulated on real time aspirations. It increases the sensitivity due to high diagnostic yield from target areas. Materials and Methods: The present study is a retrospective study of 161cases, where real time ultrasound guided FNAC of intra-abdominal and intra-pelvic masses were done from 1st July 2018 to 31st December 2019 in a tertiary cancer center. Aspirations from ovary and other pelvic masses-18 gauge, liver/gall bladder-22- 23 gauge and kidney-23 gauge spinal needles were taken respectively. Results: Total 161 cases of intra-abdominal lesions- ovary- 73 cases, liver-45 cases, kidney-27 cases, gall bladder-07 cases, colon (caecum+descending colon)-03 cases and pelvis mass- 03cases, pancreas- 02 cases and retroperitoneal lymph node-01 case were retrieved and studied. Ultrasound guided aspirates were conclusive for reporting in 145 cases, inconclusive for reporting in 10 cases and acellular/ haemorrhagic in 06 cases. There was high sensitivity and specificity of 90.9% and 100% respectively. Conclusion: Real time image guided FNAC is the method of choice for intra-abdominal masses with better cell yield and minimal complication. It permits precise localization and targeting of lesions safely. The localization is good in most of the masses but, it’s challenging in few locations. Complication like needle track seedling, discussed in many studies, was not seen in the present study. Keymessage: Image guided FNAC is very rewarding in diagnosis of intra-abdominal masses. USG guided FNAC is easy, causes minimal radiation, rapid reporting, less complication and needle tip can be easily visualized and manipulated in any direction, thus aids in faster planning if the treatment. Keywords: Real time Ultrasound guided FNAC, Intra-abdominal and intra-pelvic mass.

BACKGROUND Spinal anaesthesia is the first preference of anaesthesia in obstetric surgery. Post dural puncture headache (PDPH) is more common after C-section in young parturients. In the present world which is developing and fast-paced, brisk recovery along with minimal side effects & importantly early ambulation are now the need of the hour. This headache is more worrying to the mother who is required to tend to the newborn baby. This study compared the incidence of PDPH subsequent to subarachnoid blockade for lower segment Caesarean section (LSCS) 25G Whitacre & 25G Quincke needles. We wanted to compare the incidence of PDPH using 25G Quincke and 25G Whitacre spinal needles in patients undergoing LSCS. METHODS Two hundred (ASA II) American Society of Anaesthesiologists 11 females who were pregnant and in the age group of 20 - 50 years, planned to get sub-arachnoid blockade for C-section, were assigned randomly into two equal groups (N = 100 each). Both groups received spinal anaesthesia with 25-gauge Quincke and 25 gauge Whitacre needle. Postoperatively, incidence, site, onset, severity and duration of headache was studied. RESULTS The incidence of post spinal headache was 6 % in the Quincke group. No patients in Whitacre group had PDPH. The number of lumbar punctures required for successful sub arachnoid block was recorded in both the groups. 92 % patients from group Q and 88 % patients from group W required only one puncture. 8 % patients from group Q and 12 % patients from group W required two punctures. CONCLUSIONS It is prudent to conclude that 25G Whitacre spinal needle is a better alternative to 25G Quincke needle for reducing the incidence of post dural puncture headache in patients undergoing lower segment Caesarean section. KEY WORDS Spinal Anaesthesia, Post Dural Puncture Headache, Caesarean Section

To report our experience of percutaneous image-guided cryoablation of renal tumors located within 10 mm of the pyeloureteric junction (PUJ) and/or ureter, with hydrodissection as a stand-alone thermoprotective technique. All patients who were offered combined hydrodissection and cryoablation of the PUJ/ureter to treat stage-1 renal cell carcinoma were retrospectively reviewed. Data regarding patients, lesions, and outcomes were collected. Twenty tumors in 20 patients (13 males:7 females) with a mean age of 74.4 ± 7.5 were included. Mean tumor size was 27.6 ± 6.4 mm. Nearby vulnerable structure(s) were identified as the ureter in 5/20 cases, the PUJ in 8/20 cases and both the PUJ and the ureter in the remaining 7/20 cases (35%) cases. Mean minimal distance between the tumor and the vulnerable organ(s) was 4.8 ± 2.6 mm (range 0–10). A mean of 1.7 ± 0.6 spinal needles were used per intervention with a mean time to complete hydrodissection of 18.6 ± 13.4 min. Primary and secondary technical efficacy rates were 90% and 95%, respectively. Mean follow-up was 23.1 ± 9.2 months. There were no immediate or delayed complications, in particular no urothelial strictures. Two tumor recurrences occurred during follow-up, with a time to disease progression of 13 and 31 months, respectively. hydrodissection of the PUJ/ureter to prevent thermal injury during cryoablation is an effective technique and does not seem to compromise the efficacy of ablation at short or mid-term follow-up.

BackgroundPerforming spinal anaesthesia using the conventional popping method with a 27-gauge (27G) spinal needle is technically difficult. In this study, we compared the aspiration and conventional popping method for spinal anaesthesia using 27G Quincke-type needles.MethodsThis prospective, randomized study enrolled 90 patients, aged 19 to 65 years, with American Society of Anesthesiologists physical status I-III, who were undergoing spinal anaesthesia. Patients were randomly assigned to one of two groups using a computer-generated random number table: patients receiving spinal anaesthesia using the aspiration method, in which the needle is advanced with continuous aspiration, or the conventional popping method. The primary outcome measure was the success rate of the first attempt to perform dural puncture. Number of attempts and passages, withdrawal cases, successful attempt time, total procedure time, and actual depth of dural puncture were recorded.ResultsEighty-eight patients were included in the study. In the aspiration group, the success rate of first attempt for dural puncture was 93.3%, compared with 72.1% in the popping group (P = 0.019). Success involving needle withdrawal was recorded in 4 (8.9%) patients in the aspiration group and 13 (30.2%) in the popping group (P = 0.024). In the popping group, the number of attempts was significantly higher (P = 0.044), and total procedure time was significantly longer (P = 0.023). Actual depths of dural puncture were deeper in the popping group than in the aspiration group (P = 0.019).ConclusionsThe aspiration method using a 27G Quincke-type needle offers clinical benefits for dural puncture compared with the conventional popping method for spinal anaesthesia.Trial registrationClinical research information service number:KCT0002815, registered 21/Apr/2018. Retrospectively registered.

Background: One of the complications of spinal anesthesia especially in pregnant women is post dural puncture headache (PDPH). Objectives of the study was to compare the incidence of PDPH between 25G and 27G Whitacre spinal needles and to compare the ease of lumbar puncture. Materials and Methods: Two hundred elective caesarean section patients were allocated into two groups of 100 each. In Group 1, Spinal anesthesia was given with 25 G and in group 2 with 27 G Whitacre needle. Results: Incidence of PDPH between two groups is not statistically significant with zero percent incidence. It was technically easier to perform lumbar puncture with 25 G Whitacre needle than 27 G needle which was statistically significant. Conclusion: It is technically easier to perform lumber puncture with 25G whitacre needle with no difference in the incidence of PDPH between 25G and 27G Whitacre needle.

BACKGROUND Concern has been raised that Sprotte needles predispose to spinal anes-thesia failure. Nevertheless, these needles are associated with a low incidence of postdural puncture headache. The impact of the paramedian approach to postdural puncture headache remains controversial. The objective of this prospective randomized study was to compare Sprotte, Quincke and Atraucan needles as well as the midline and the paramedian approach in terms of postdural puncture headache and spinal anesthesia failure in patients undergoing Caesarean section. METHODS 655 patients were randomized to 5 groups. A midline approach was used in four groups. The spinal needles were the 25G Sprotte, 27G Sprotte, 26G Atraucan and 25G Quincke. In the fifth group a 25G Quincke needle was used by the paramedian approach. RESULTS The incidence of postdural puncture headache was 0% in both 25G and 27G Sprotte groups, 2.5% in the 26G Atraucan group, and 7.2% and 2.7% in the 25G Quincke midline and paramedian approach respectively. A significant difference in terms of postdural puncture headache was found between 25G Sprotte and 25G Quincke needles (P = 0.004), while the failure rate was similar between these two needles. A significant difference in spinal anesthesia failure rate was observed between midline and paramedian approaches (P = 0.041). CONCLUSIONS Sprotte but not Atraucan needle design correlates with lower incidence of postdural puncture headache compared to Quincke design. Sprotte needles are not associated with a higher spinal anesthesia failure compared to Quincke needles. The incidence of postdural puncture headache by the paramedian approach is not significantly reduced whereas the spinal anesthesia failure rate is increased in comparison to the midline approach.

BackgroundThis double-blind, randomized trial compared dural puncture epidural analgesia (DPEA) for labor using 25-gauge and 27-gauge pencil point spinal needles. We hypothesized that both needle sizes would result in similar onset time (equivalence margin=2.5 min) and therefore designed the study as an equivalence trial.MethodsOne hundred and forty patients undergoing labor were randomized to DPEA with 25-gauge (n=70) or 27-gauge (n=70) pencil point spinal needles. After the placement of the epidural catheter, a bolus of 20 mL of bupivacaine 0.125% and fentanyl 2 µg/mL was administered to all subjects. Thereafter, patients received boluses of 12 mL of bupivacaine 0.125% every 2 hours as needed.A blinded investigator recorded the onset time (defined as the temporal interval required to achieve a pain score ≤1 on a 0–10 scale), S2 block, sensory block height (30 min after the initial bolus of local anesthetic), presence of motor block (30 min after the initial bolus of local anesthetic), number of top-up doses required during labor and incidence of postural headache.ResultsOut of the 140 recruited patients, 135 were retained for analysis. Compared with their 27-gauge counterparts, 25-gauge pencil point spinal needles provided a 1.6 min shorter DPEA onset (95% CI of the difference of the means: −3.2 to −0.1 min). However, there were no intergroup differences in terms of S2 block, sensory block height, motor block, number of top-up doses and incidence of postural headache.ConclusionDural puncture epidural analgesia with 25-gauge pencil point spinal needles provides a 1.6 min shorter onset time than DPEA with 27-gauge spinal needles. Although statistically significant, such a difference may not be clinically relevant. Further investigation is required to compare 25-gauge and 27-gauge spinal needles for DPEA in the setting of different local anesthetic infusion strategies.Trial registration numberNCT03389945.

Objective Combined spinal-epidural (CSE) anesthesia is a widely used neuraxial anesthetic technique. In clinical practice, failed dural puncture during needle-through-needle technique occasionally occurs, with incidence of 5%-29%. We radiologically evaluated four cases of failed dural puncture during needle-through-needle CSE anesthesia. Case series Four patients received CSE anesthesia for elective orthopedic surgery. CSE procedures were performed in the same manner using a CSE device for needle-through-needle technique. An epidural needle was inserted in midline at L4/5 interspaces using loss of resistance to air whilst patients lay in the lateral decubitus position. The spinal needle was then inserted through the epidural needle for subarachnoid block, however, negative cerebrospinal flow was identified. Subsequently, radiographic imaging using C-arm fluoroscopy was performed to evaluate the status of needles. We found that epidural needles were considerably deviated from the midline, while spinal needles exited epidural needles, not through back holes, but through the Tuohy curve in three patients. In one patient, when the spinal needle was inserted to 12 mm, the anesthesiologist felt the needle touching the bony structure. The spinal needle was in contact with the superior articular process of the fifth lumbar vertebra, which was confirmed by C-arm radiography. Conclusion Excessive paramedian deviation of the epidural needle may affect dural puncture during needle-through-needle CSE technique. Moreover, wrong passage of the spinal needle through Tuohy curve instead of the back hole, may contribute to failure of dural puncture.

Study objective This systematic review aimed to summarize the evidence derived from randomized controlled trials (RCTs) comparing dural puncture epidural analgesia (DPEA) and conventional lumbar epidural analgesia (LEA) for women undergoing labor. Interventions The MEDLINE and EMBASE databases were searched from inception to July 2018 in order to find RCTs published in the English language, which investigated DPEA in laboring women. Main results Six RCTs were included in the final analysis. Their collective results remain ambiguous. Dural puncture with small (i.e., 26- or 27-gauge) spinal needles seems to confer either minimal benefits or improved analgesic quality and lower pain scores in the first 10 min. Dural puncture with 25-gauge spinal needles has been reported to provide higher success rate than conventional LEA in one trial; however two other studies could only agree on the fact that DPEA results in improved sacral blockade and fewer unilateral blocks compared to LEA. Conclusions The current evidence regarding DPEA for labor analgesia remains ambiguous. Future research should investigate the optimal (spinal) needle size for dural puncture as well as factors governing transmeningeal flux of local anesthetics and opioids in the presence of a dural hole.

Lumbar puncture (LP) procedures are commonly performed for diagnostic purposes by neurologists and emergency physicians, and for intrathecal local anesthesthetic administration for spinal anesthesia by anesthesiologists. Complications include post-dural puncture headache, meningitis, epidural hematoma and neurological injury. A recent article by Ertas et al in the Journal of Clinical Neurology and Neurosurgery highlights the risks of intervertebral disc injury during LP. Disc injury, has been shown to initiate degenerative chances in animal models. During an LP the degree of damage to the intervertebral disc is probably determined by the force applied, and nature and diameter of the needle. It is perhaps time to reprise the evidence concerning needle choice and the incidence of complications. A range of traumatic (cutting) and atraumatic (pencil point) LP needles have been developed in a variety of sizes. At present there is no evidence that atraumatic needles reduce the incidence of back pain. A large body of evidence shows that atraumatic needles are easy to use and are associated with a lower incidence of post-dural puncture headache, and do not increase the rates of failure or neurological injury. As a result, the use of atraumatic needles for spinal anesthesia is almost universal. Adoption of atraumatic needles in neurology practice has been slow and patchy. We challenge our neurological colleagues to follow the recommendations of several international guidelines, including those of the American Academy of Neurology, and incorporate the use of narrower gauge atraumatic needles for the benefit of their patients.

Tenodesis and tenotomy are the main surgical options to treat different pathologies of the long head of the biceps tendon. Maintaining the functionality of the tendon during tenodesis makes it more preferable surgical option. The consensus on the most advanced tenodesis technique has not been reached. The article presents the arthroscopic all-inside technique of suprapectoral tenodesis of the biceps tendon using the technique of “zone marking” with 2 spinal needles or pins., Technique Video Video 1 The video describes a technique of arthroscopic suprapectoral tenodesis of the long head of the biceps with interference screw. After diagnostic arthroscopy, the intra-articular part of the biceps is marked by passing the first spinal needle through the tendon. The next step is tenotomy of LHBT, which is performed close to superior labrum using an arthroscopic scissor. LHBT stump treatment is performed with a radiofrequency device. The anterolateral portal visualizes the marking needle in the projection of the bicipital groove. Here bursectomy, subacromial decompression, and LHBT fixation with the second spinal needle or pin are performed. The transverse ligament is dissected with the radiofrequency device. The second spinal needle is used to fix the tendon to the humerus. The biceps tendon is removed from the opened groove into the subdeltoid space. Then, a hole is drilled in the middle third of the groove along the guide pin. In the last stage of the operation, the biceps tendon is inserted into the canal using a grasper. Along the nitinol guidewire in the canal, the tendon is fixed with an interference screw. After the reliability of fixation is confirmed with the hook probe, the second spinal needle is removed. (LHBT, long head of the biceps tendon.)

Introduction: Spinal anesthesia is a technique performed since more than a century and the introduction of hyperbaric anesthetics allowed the anesthesiologists to be more selective when using this technique. The aim of this study is to show the in vitro flow patterns of a hyperbaric dye solution through 27 G Quincke and Sprotte spinal needles, injected at different speeds, in a lower-density fluid. Methods: A simulator was made using a gummy-like sponge and a disposable plastic urine glass, filled with saline solution, which has a similar density to cerebrospinal fluid (CSF). A hyperbaric dye solution was composed by mixing 3 ml of plain methylene blue with 1 ml of glucose 33%. We used both 27 G Quincke and Sprotte spinal needles to perform a bevel up and a bevel down injection with both slow (15 s) and fast (4 s) injection speed of 0.5 mL hyperbaric dye solution. All the injections were performed using a preset syringe pump and recorded by a camera. Results: The least selectivity was observed after a bevel up-fast injection through the 27 G Sprotte needle, followed by both bevel up and down fast injections through the 27 G Quincke needle. On the contrary, the best selectivity was observed after a bevel down-slow injection through the 27 G Sprotte needle, followed by both bevel up and down slow injections through the 27 G Quincke needle. Conclusion: When a 27 G Sprotte needle is used to inject a hyperbaric solution in a lower-density fluid-like CSF, the spread depends on both the bevel direction and the injection speed.

Background and Study Objective: To treat PDPH by simple and effective means using transnasal Sphenopalatine ganglion block. PDPH (post dural puncture headache) is one of the very well known complications. Management of PDPH is always challenging to anesthesiologist. Though the incidence of PDPH has reduced with new small spinal needles and needle tip designs, still occasional PDPH cases are observed.

Background: Multiple complications including hypotension, nausea, vomiting, urinary retention, transient neurological symptoms and headache have been associated with spinal anaesthesia. Importantly, post dural puncture headache (PDPH) varies with the type and size of spinal needle employed for inducing anaesthesia. Here, we aimed to compare the frequency of PDPH in patients underwent spinal anaesthesia for elective caesarean section using 25-gauge (G) and 29-G Quincke spinal needle.Methods: We designed a randomized control trial at Obstetrics and Gynecology Operation Theatres, Jinnah Hospital, Lahore. A total of 152 patients having age 30.28±8.21 years were enrolled in the study and divided into two groups each comprising of 76 patients. In group 1, spinal anaesthesia was performed using 25-G Quincke spinal needle while in group 2 spinal anaesthesia was administered employing 29-G Quincke spinal needle. A standard dose of 10.5-12.0 mg (1.4-1.6 ml) of 0.75% bupivacaine is infiltrated in subarachnoid space at lumber region L3-L4 or L4-L5 following aseptic measures. The patients were evaluated for PDPH during the follow up period.Results: The previous history of PDPH was observed in 20.39% patients. The comparative study showed that the PDPH was observed in 12 (15.7%) patients in group 1 while the group 2 revealed PDPH in only 2 (2.6%) patients.Conclusions: Thus 29-G spinal needle can be regarded as a better option to reduce PDPH in patients subjected to spinal anaesthesia for elective cesarean in contrast to the use of 25-G Quincke spinal needle.

Post-Dural puncture headache (PDPH) is one of the most common complications encountered by physicians following spinal anesthesia or lumbar puncture. This study was done for evaluating the incidence of PDPH following spinal anesthesia in the south Indian population using various gauges of Quinckes spinal needle.

Introduction Spinal anesthesia involves the administration of a dose of local anesthesia into the intrathecal space of the lumbar spine, using spinal needles with varying characteristics and design. When completing the administration of spinal anesthesia, you may check the volume of fluid remaining inside the spinal needle. Objective To measure and compare the volume of residual fluid following the administration of spinal anesthesia using three different brands of 27 gauge spinal needles. Methods This is an observational analytical cross-section trial for which tree types of 27 gauge commercial needles were selected: BD Whitacre pencil point, Spinocan Quincke sharp point, and Disposable spinal needle. Following the administration of spinal anesthesia, the same operator, without detaching the syringe from the needle, deposited the residual volume into a collection tube so that a second operator quantifies the volume using a precision micropipette. Results The residual volume obtained from the 27G spinal needles showed a statistically significant difference in favor of the BD Whitacre needles (P Conclusions The BD Whitacre pencil point proved to lodge less residual volume following spinal anesthesia. No clinical implications can be made from this finding and new studies are required to ratify these results.

Resumo Justificativa e objetivo Investigar as diferencas no numero de celulas epiteliais escamosas transportadas para o canal medular por tres tipos diferentes de pontas de agulhas espinhais do mesmo tamanho. Metodos Os pacientes foram alocados em tres grupos (Grupo I, Grupo II, Grupo III). Raquianestesia foi administrada aos pacientes do Grupo I (n = 50) com agulha Quincke de 25G, do Grupo II (n = 50) com agulha espinhal ponta de lapis de 25G e do Grupo III (n = 50) com agulha atraumatica nao cortante de curvatura especial. A primeira e terceira gotas de liquido cefalorraquidiano (LCR) foram colhidas de cada paciente para amostra e cada gota foi colocada em lâmina para exame citologico. As celulas epiteliais escamosas nucleadas e nao nucleadas sobre as lâminas de esfregaco foram contadas. Resultados Houve diferenca estatisticamente significativa entre os grupos em relacao ao numero de celulas epiteliais escamosas na primeira gota (p 0,05, para cada grupo). Conclusoes Neste estudo de pontas de agulha diferentes, verificamos que com a agulha atraumatica de curvatura especial o numero de celulas transportadas foi significativamente menor, em comparacao com as agulhas Quincke e ponta de lapis.

Spinal needles with different diameters can be used to prevent side effects in patients undergoing spinal anaesthesia. However, the velocity of local anaesthetic changes through the spinal needle depending on the diameter of it. Local anaesthetic injection velocity has been reported to be associated with the spinal block level. We aimed to compare spinal needles of different diameters with the same local anaesthetic volumetric flow rate in terms of spinal blockade and hemodynamics in obstetric patients. Eighty-four patients received spinal anaesthesia by either a 25G needle or 29G with the same volumetric flow rate. Block levels, adverse effects, ephedrine given and a success rate of spinal anaesthesia were significantly higher in 25G than in 29G (p .05). Athough the use of 29G was associated with a low level of block, a sufficient block level was generated for caesarean section. Furthermore, in spite of the technical difficulty, use of 29G was accompanied by a decreased incidence of maternal hypotension, bradycardia and a lowered ephedrine administration. Impact statement Local spinal anaesthetic injections at faster flows cause turbulent flow leading to lower anaesthesia concentrations. The control of spinal anaesthesia levels has some difficulties due to anatomical repositioning, especially in pregnant patients. Also, it can cause frequent hemodynamic complications including hypotension and bradycardia, complications that may also have inadvertent effects on foetus. In this study, we showed that smaller diameter spinal needles provided safer spinal anaesthesia levels and a lower incidence of hemodynamic complications.

We investigated the flow rates of 25-G and 27-G spinal needles, of 90-mm and 120-mm lengths, from Vygon, BD, B. Braun and Pajunk; the needles had either a Luer connector, or a Surety® or UniVia® non-Luer connector. We used a bench-top model of entering the spinal space, pressurised to 35 cmH2 O to simulate cerebrospinal fluid pressure in the sitting position. We examined the time to first appearance of simulated cerebrospinal fluid in the needle hub, as well as the amount of fluid collected over 120 s after the needle was introduced. The mean (SD) times to first appearance of fluid in the needle hub of Luer spinal needles varied from 0.36 (0.22) s for the 25-G 90-mm BD to 3.14 (0.72) s for the 27-G 120-mm B. Braun, and in the non-Luer spinal needles from 0.22 (0.17) s for the 25-G 90-mm B. Braun to 2.99 (0.71) s for the 27-G 120-mm Pajunk. There was a significant difference in the time to first appearance of fluid in the needle hub between Luer and non-Luer needles of the same type for seven of 14 comparisons made, of which four showed slower appearance of fluid in the non-Luer version. In some of these cases, the time to appearance of fluid was nearly twice as long with the non-Luer counterpart. The mean (SD) weight of fluid collected in 120 s using the Luer spinal needles varied from 0.21 (0.05) g for the 27-G 120-mm Pajunk to 1.21 (0.18) g for the 25-G 90-mm Vygon, and using the non-Luer spinal needles from 0.25 (0.05) g for the 27-G 120-mm Pajunk to 1.55 (0.05) g for the 25-G 90-mm B. Braun. All of the needle types showed a greater weight of fluid collected using the non-Luer compared with the Luer version, with six of the 14 needle types showing a significant difference. Significant variations in flow were also seen between the same needle type from different manufacturers. We conclude that changing from Luer to non-Luer versions of spinal needles does not merely change the hub design and connection, but may introduce important differences in function.

To evaluate the accuracy of a fusion imaging guidance system using ultrasound (US) and computerized tomography (CT) as a real-time imaging modality for the positioning of a 22-gauge needle in the liver.The spatial coordinates of 23 spinal needles placed at the border of hepatic tumors before radiofrequency thermal ablation were determined in 23 patients. Needles were inserted up to the border of the tumor with the use of CT-US fusion imaging. A control CT scan was carried out to compare real (x, y, z) and virtual (x', y', z') coordinates of the tip of the needle (D for distal) and of a point on the needle located 3 cm proximally to the tip (P for proximal).The mean Euclidian distances were 8.5 ± 4.7 mm and 10.5 ± 5.3 mm for D and P, respectively. The absolute value of mean differences of the 3 coordinates (|x' - x|, |y' - y|, and |z' - z|) were 4.06 ± 0.9, 4.21 ± 0.84, and 4.89 ± 0.89 mm for D and 3.96 ± 0.60, 4.41 ± 0.86, and 7.66 ± 1.27 mm for P. X = |x' - x| and Y = |y' - y| coordinates were7 mm with a probability close to 1. Z = |z' - z| coordinate was not considered to be larger nor smaller than 7 mm (probability7 mm close to 50%).Positioning errors with the use of US-CT fusion imaging used in this study are not negligible for the insertion of a 22-gauge needle in the liver. Physicians must be aware of such possible errors to adapt the treatment when used for thermal ablation.

Background We hypothesized that the click perceived when puncturing the dura-arachnoid with fine-gauge spinal needles can be subjectively identified, and investigated whether it may be distinguishable among different needle types. Methods Subjective and objective evaluations were performed. First, physicians punctured the polyamide film or porcine dura mater (n = 70 and n = 20, respectively) with seven types of spinal needles and numerically evaluated the perceived click sensations. Using an 11-point numerical rating scale (from “0” for “no click sensation” to “10” for “the strongest click perceived”) data, subjective differentiation among needle types was assessed. Second, in the objective part of the study, total forces elicited by polyamide film or porcine dura mater punctures with each needle were measured using a biomechanical testing device, and load-displacement curves evaluated. Third, the results of subjective and objective evaluations were compared. Results All participants recognized the click and could discriminate among needles of different tip shape. The load-displacement curves for polyamide film and porcine dura mater were similar and needle-specific. The subjective numerical rating scale values corresponded well with the objectively measured changes in total forces (R2 = 0.862 and R2 = 0.881 for polyamide film and porcine dura mater, respectively), indicating that an increase in the largest drop in total force value of 0.30 N or 0.21 N would produce an increase of numerical rating scale value of 1 for polyamide film and porcine dura mater, respectively. Conclusions We provide an objective proof of the click sensation felt upon dural puncture using different fine-gauge spinal needles. Click recognition could be used as an additional indicator of successful spinal puncture.

Background and Objective: In the last several decades, there has been a shift from general anaesthesia to regional anaesthesia for caesarean section worldwide. This rise notwithstanding, it is pertinent to determine the factors associated with the wholesome application of spinal anaesthesia for caesarean section in Nigeria. Method: A snap-shot survey was conducted in some selected hospitals in Nigeria. The survey determined the sociodemographic characteristics of patients, indication for surgery, grade of anaesthesia provider, contraindication to spinal anaesthesia and any other factor that may be noticed in the selected hospital (lack of appropriate drugs, spinal needles, absence of relevant expertise etc). Result: A total of 99 patients were attended to in four of the selected six hospitals within the study period. Thirty six (36.4%) women were nulliparous and maternal factors (82.8%) were the leading indications for caesarean section. Consultant anaesthetists (23.2%) and Senior Registrars (35.4%) were the leading anaesthesia providers for the caesarean sections. Eighty five (85.9%) patients received spinal anaesthesia and 14 (14.1%) had general anaesthesia for the Caesarean section. Fetal indication for Caesarean section was associated with a 3-fold chance of using general anaesthesia for the surgery (p = 0.0138, RR = 3.6, 95%CI 1.44 – 9.1). Conclusion: Over 85% of Caesarean sections in some hospitals in Nigeria were conducted under spinal anaesthesia. Fetal indications for caesarean section provoked over a 3-fold increase in general anaesthesia for caesarean section. The use of general anaesthesia for caesarean delivery was due to fetal indications for surgery, antepartum haemorrhage and failed spinal anaesthesia.

Introduction: One of the important spinal anesthesia complications is the occurrence of postdural puncture headache (PDPH). The incidence of PDPH is related to the age, the size and tip shape of the spinal needle used and the type of surgery. Incidence may vary depending on the type and size of needle. This study was conducted to compare the frequency of PDPH using different kind of spinal needles.Methods: Data of 81 patients undergoing spinal anesthesia for lower abdominal surgery were collected for the study. Patients were divided into three groups as Group Q (n = 27), Group P (n=27) and Group A (n = 27) according to the spinal needle used for spinal anesthesia. Headache incidences during five days period postoperatively were noted.Results: The overall incidence of PDPH in this young adult population was 13.6% (11 patients of 81). PDPB was encountered in 14.8%, 11.1% and 14.8% of patients in Groups A, Q and P, respectively.Conclusion: All spinal needles used in our study have the potential to lead to PDPH in young patients undergoing spinal anesthesia for lower abdominal surgery. We did not see any advantage of using 25G Atraumatic spinal needle in young patients. Introduction: One of the important spinal anesthesia complications is the occurrence of postdural puncture headache (PDPH). The incidence of PDPH is related to the age, the size and tip shape of the spinal needle used and the type of surgery. Incidence may vary depending on the type and size of needle. This study was conducted to compare the frequency of PDPH using different kind of spinal needles.Methods: Data of 81 patients undergoing spinal anesthesia for lower abdominal surgery were collected for the study. Patients were divided into three groups as Group Q (n = 27), Group P (n=27) and Group A (n = 27) according to the spinal needle used for spinal anesthesia. Headache incidences during five days period postoperatively were noted.Results: The overall incidence of PDPH in this young adult population was 13.6% (11 patients of 81). PDPB was encountered in 14.8%, 11.1% and 14.8% of patients in Groups A, Q and P, respectively.Conclusion: All spinal needles used in our study have the potential to lead to PDPH in young patients undergoing spinal anesthesia for lower abdominal surgery. We did not see any advantage of using 25G Atraumatic spinal needle in young patients.

Background and Aims: Post-dural puncture headache is seen more frequently in pregnant women due to stress, dehydration, intra-abdominal pressure, and insufficient fluid replacement after delivery. Obesity protects against post-dural puncture headache in pregnant women; increased intra-abdominal fat tissue reduced cerebrospinal fluid leakage by increasing the pressure in the epidural space. Therefore, this study investigated the influence of body mass index on post-dural puncture headache in elective cesarean section patients in whom 27G spinal needles were used. Material and Methods: The study included 464 women who underwent elective cesarean section under spinal anesthesia. Dural puncture performed with a 27G Quincke spinal needle at the L3-4 or L4-5 intervertebral space and given 12.5 mg hyperbaric bupivacaine intrathecally. The patients were questioned regarding headache and low back pain 6, 12, 24, and 48 h after the procedure, and by phone calls on days 3 and 7. Results: Post-dural puncture headache developed in 38 (8.2%) patients. Of the patients who developed post-dural puncture headache, 23 (60.5%) had a body mass index

Objectives: The aim of this study is to assess deformation of the tip and deflection from the axis of 22-gauge Quincke needles when they are used for diagnostic lumbar puncture (LP). Thus, it can be determined whether constructional alterations of needles are important for predicting clinical problems after diagnostic LP. Materials and Methods: The 22-gauge Quincke needles used for diagnostic LP were evaluated. A specially designed protractor was used for measurement and evaluation. Waist circumference was measured in each patient. Patients were questioned about headaches occurring after LP. Results: A total of 115 Quincke-type spinal needles used in 113 patients were evaluated. No deflection was detected in 38 (33.1%) of the needles. Deflection between 0.1° and 5° occurred in 43 (37.3%) of the needles and deflection ≥ 5.1° occurred in 34 patients (29.6%). Forty-seven (41.5%) patients experienced post lumbar puncture headache (PLPH) and 13 (11.5%) patients experienced intracranial hypotension (IH). No statistically significant correlation between the degree of deflection and headache was found (P > 0.05). Epidural blood patch was performed for three patients. Deformity in the form of bending like a hook occurred in seven needles and IH occurred in six patients using these needles. Two of the needles used in three patients requiring blood patch were found to be bent. Conclusion: Deformation of needles may increase complications after LP. Needle deformation may lead to IH. In case of deterioration in the structure of the needle, termination of the puncture procedure and the use of a new needle could reduce undesirable clinical consequences, especially IH.

Background and objectives: To investigate the differences in the number of squamous epithelial cells carried to the spinal canal by three different types of spinal needle tip of the same size. Methods: Patients were allocated into three groups (Group I, Group II, Group III). Spinal anesthesia was administered to Group I (n = 50) using a 25G Quincke needle, to Group II (n = 50) using a 25G pencil point spinal needle, and to Group III (n = 50) using a non-cutting atraumatic needle with special bending. The first and third drops of cerebral spinal fluid (CSF) samples were taken from each patient and each drop was placed on a slide for cytological examination. Nucleated and non-nucleated squamous epithelial cells on the smear preparations were counted. Results: There was statistically significant difference between the groups in respect to the number of squamous epithelial cells in the first drop (p 0.05 for each group). Conclusions: In this study of different needle tips, it was seen that with atraumatic needle with special bending a significantly smaller number of cells were transported when compared to the Quincke tip needles, and with pencil point needles. Resumo: Justificativa e objetivo: Investigar as diferenças no número de células epiteliais escamosas transportadas para o canal medular por três tipos diferentes de pontas de agulhas espinhais do mesmo tamanho. Métodos: Os pacientes foram alocados em três grupos (Grupo I, Grupo II, Grupo III). Raquianestesia foi administrada aos pacientes do Grupo I (n = 50) com agulha Quincke de 25G, do Grupo II (n = 50) com agulha espinhal ponta de lápis de 25G e do Grupo III (n = 50) com agulha atraumática não cortante de curvatura especial. A primeira e terceira gotas de líquido cefalorraquidiano (LCR) foram colhidas de cada paciente para amostra e cada gota foi colocada em lâmina para exame citológico. As células epiteliais escamosas nucleadas e não nucleadas sobre as lâminas de esfregaço foram contadas. Resultados: Houve diferença estatisticamente significativa entre os grupos em relação ao número de células epiteliais escamosas na primeira gota (p 0,05, para cada grupo). Conclusões: Neste estudo de pontas de agulha diferentes, verificamos que com a agulha atraumática de curvatura especial o número de células transportadas foi significativamente menor, em comparação com as agulhas Quincke e ponta de lápis. Keywords: Spinal anesthesia, Cerebrospinal fluid, Spinal needles, Epithelial cells, Palavras-chave: Raquianestesia, Líquido cefalorraquidiano, Agulhas espinhais, Células epiteliais

Background: The postdural puncture headache (PDPH) and postdural puncture backache (PDPB) are well-known complications of spinal anesthesia. There are some attempts to reduce the frequency of complication such as different design of the spinal needles. Aims: The primary outcome of this study is to compare the incidence of PDPH between 26-gauge Atraucan and 26-gauge Quincke spinal needles in elective cesarean operations. The severity of symptoms, the incidence of backache, technical issues, and comparison of cost of needles are secondary outcomes. Materials and Methods: After Investigational Review Board approval, a randomized, prospective, double-blinded study was designed in 682 American Society of Anesthesiologists I–II women having elective cesarean operations under spinal anesthesia. Patients were divided into two groups as 26-gauge Atraucan Group A (n = 323) and 26-gauge Quincke spinal needles Group Q (n = 342). All patients were questioned about backache 1 week later. Differences between categorical variables were evaluated with Chi-square test. Continuous variables were compared by Student's t-test for two independent groups. A two-sided P < 0.05 was considered statistically significant for all analyses. Results: There were no significant differences between groups in all demographic data. The one attempt success rate of the dural puncture in Group A (70,58%) and in Group Q (69.3%) was similar (P > 0.05). The incidence of PDPH was 6.5% in Group A and 4.9% in Group Q (P > 0.05). The epidural blood patch was performed to the three patients in Group A and five patients in Group Q who had severe headache (P > 0.05). The incidence of PDPB was 4.33% versus 2.04% in Group A and Group Q (P > 0.05). Conclusions: The incidence of complication rates and technical handling characteristics did not differ between two groups. Quincke needle is cheaper than Atracaun needle, so it can be a cost-effective choice in obstetric patients.

We investigated the strength of commonly used spinal needles in relation to the amount of deformation, and registered forces during standardised testing. We investigated differences between manufacturers for the same length and gauge of Luer and non-Luer needles, and examined the effect of the internal stylet in terms of needle strength. A specialised rig was designed to perform the testing in both the horizontal and axial plane, reflecting common industrial tests and clinical use. Needles from four commonly used manufacturers were used (Vygon, Becton Dickinson, B Braun, and Pajunk). Needles of 25 G and 27 G were tested in 90-mm and 120-mm lengths. We found significant differences in terms of the size of final deformation and 'toughness'/resistance to deformation between needles of different brands. There were also significant differences between horizontal tests conducted as an industry standard and our own axial test. This may have bearing on clinical use in terms of the incidence of bending and breakage. The presence of the internal stylet resulted in significantly greater toughness in many needles, but had little effect on the degree of deformation. Comparison of Luer and non-Luer needles of the same brand and size showed few significant differences in strength. This result is reassuring, given the imminent change from Luer to non-Luer needles that is to occur in the UK.

Background: Lumbar puncture is a standardized, routine diagnostic procedure in the diagnosis of neurological diseases. Post-duarl puncture headache (PDPH) is a common complication which occurs in 10 to 30 % of patients. Although the incidence of PDPH is much lower with the use of small, non-cutting needles, neurologists in Slovenia routinely use the classical traumatic spinal needles.Methods: In the article we provide an overview of a research concerned with the use of traumatic and atraumatic needles in the procedure with the emphasis on complications of the lumbar puncture. We present American and European recommendations for lumbar puncture procedure.Conclusions: International recommendations for neurologists advise the use of atraumatic spinal needles for lumbar puncture. We recommend to Slovenian neurologists to start using the atraumatic needles for elective lumbar punctures and hence provide neurological patients with better quality and cheaper long-term care.

Standard external landmarks have been suggested as a guide for in-office percutaneous nerve evaluation (PNE), but validity of these landmarks has not been assessed. Our objective was to determine whether the standard 9 cm from the tip of the coccyx indicates the position of the S3 sacral foramen and whether other boney landmarks and measurements improved positioning. Measurements and distances between external boney landmarks were obtained in 22 embalmed cadavers. Spinal needles were placed 9 cm superior to the coccyx and 2 cm lateral to midline bilaterally. After dissection, internal measurements relating to sacral length, position of S3, and location of the needle in relation to S3 were recorded. Correlations among measured variables were assessed using descriptive statistics. Mean distance from the tip of coccyx to S3 was 9.26 cm (±0.84), from S3 to midline 2.30 cm (±0.2); from needle to S3 1.25 cm, and needle placement was as likely to be placed above or below S3; and S2-S3 and S3-S4 interforamenal distance 1.48 cm (±0.30) and 1.48 cm (±0.24), respectively. Mean distance from S3 to sacroiliac joint (SIJ) was shorter than S2 to SIJ. All associations between external measurements and length from tip of coccyx to S3 were not significant. A distance 9 cm from the tip of the coccyx is a reasonable starting landmark for in-office blind PNE. However, given the variability in coccyx length, caution should be taken; also, sensory-motor response is necessary to confirm proper placement.

Introduction: Several techniques have been used for arthroscopic repair of middle segment, posteromedial or posterolateral corner tears of the meniscus. One of the commonly used methods is the inside-out double arm needle technique. Surgical Technique: We have developed a vertical mattress absorbable suture technique. It is easy to perform with a small sized skin incision for knot tying. This technique just necessitates 1 or 2 spinal needles for repair. Materials and Methods: Between March 2010 and February 2012, 20 menisci were treated by this technique, a modified method of the outside-in vertical meniscal repair using a spinal needle and No. 2 PDS absorbable suture material. Evaluation of clinical results was done using the Lysholm score. Results: The mean preoperative Lysholm score was 63.9 and the mean postoperative score was 97.3. A second look arthroscopy was performed in 13 knees (65%) and the repair sites were well healed. Conclusions: We recommend this method as an alternative technique for repair of the middle segment, posteromedial or posterolateral corner of the meniscus.

Background: The present study was conducted to compare three different Quincke’s spinal needles i.e. 23, 25 and 26 gauge in patients undergoing elective surgery under spinal anaesthesia (SA).Methods: The prospective randomized double-blind study was conducted on 150 male patients in the age group of 18-50 yrs., having physical status class I to II, scheduled for elective surgery under SA. Patients were randomly divided into three groups comprising 50 patients each. SA was administered using Quincke’s spinal needles of 23, 25 and 26 gauge in group 1, 2 and 3 respectively. Ease of insertion, number of attempts and time of appearance of CSF and incidence of PDPH was recorded in all the patients.Results: Ease of insertion was graded easy in 98%, 84% and 82% in group 1, 2 and 3 respectively. First attempt success rate was highest in group 1, (98%). Meantime for appearance of CSF beyond hub was maximum in group 3 i.e. 14.60±2.56 sec. Mild PDPH was reported in 6% and 2% patients after 24 hrs in group 1 and group 2 respectively.Conclusions: Finer spinal needle proved to be more dependable in generating less traumatic effect on the dura and preventing PDPH but are technically more difficult thus decreasing first attempt success rate.

In this article, we provide a literature review of cranial nerve (CN) VI injury after dural-arachnoid puncture. CN VI injury is rare and ranges in severity from diplopia to complete lateral rectus palsy with deviated gaze. The proposed mechanism of injury is cerebrospinal fluid leakage causing intracranial hypotension and downward displacement of the brainstem. This results in traction on CN VI leading to stretch and neural demyelination. Symptoms may present 1 day to 3 weeks after dural-arachnoid puncture and typically are associated with a postdural puncture (spinal) headache. Resolution of symptoms may take weeks to months. Use of small-gauge, noncutting spinal needles may decrease the risk of intracranial hypotension and subsequent CN VI injury. When ocular symptoms are present, early administration of an epidural blood patch may decrease morbidity or prevent progression of ocular symptoms.

Avaliaram-se duas novas técnicas de inseminação laparoscópica intrauterina com o uso de agulha espinhal em ovinos. Foram realizadas quatro etapas experimentais, sendo os animais separados em dois grupos em cada etapa. Para tanto, foram utilizados os posicionamentos quadrupedal e dorsal. Realizou-se a inseminação de 80 ovinos após a sincronização de cio. Verificou-se que os acessos laparoscópicos propostos foram viáveis para a inseminação em ovinos. Considerou-se que a inseminação em posicionamento quadrupedal foi tecnicamente mais difícil se comparada ao acesso laparoscópico em decúbito dorsal, porém, com o aprimoramento da técnica e na dependência dos resultados quanto aos índices de prenhez, poderá se tornar procedimento adequado para a inseminação de ovelhas. This study evaluated two new laparoscopic intrauterine insemination techniques with spinal needles in sheep. Four experimental stages were done, in which the animals were separated into two groups aiming to evaluate the techniques used. We used a total of 80 estrus-synchronized sheep, which were placed in quadrupedal or dorsal recumbence. The results showed that both insemination techniques using a spinal needle are feasible, but the quadrupedal insemination is technically more difficult compared to the laparoscopic approach in the dorsal position. With technical improvement and depending on the results in relation to pregnancy rates, this access could be considered an alternative procedure for sheep insemination.

Aim: The rate of postdural puncture headache (PDPH) was compared after caesarean section with spinal anesthesia using the 25 gauge spinal needle with the 27 gauge. Methods: Present study is a randomized clinical trial and 220 full term women entered for caesarean section. We entered full term women randomly for spinal anesthesia with the 25 gauge (group A) and 27 gauge (group B) Quincke spinal needles. In 3 postoperative days, we fallowed and compared Participants in 2 groups for the rate and severity of PDPH. PDPH was defined occipital or frontal headache that made hard the position on sitting or standing. Results: Data of 220 patients were analyzed. The rate of PDPH was significantly higher in women in group A compared to group B at first (P=0.015), second (P=0.037) and third (P=0.005) follow up days. The severity of the PDPH was not significantly different between 2 groups in three follow up days. The rate of success in spinal anesthesia achievement was not significantly different between 2 groups. Conclusion: The results of present study recommended that the size of spinal needle can effect on the rate of PDPH after caesarean section.