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An In Vivo Evaluation of Four Spinal Needles Used for the Combined Spinal-Epidural Technique

1998; Lippincott Williams & Wilkins; Volume: 86; Issue: 3 Linguagem: Inglês

10.1097/00000539-199803000-00013

1526-7598

C. H. Herbstman, J. B. Jaffee, Kenneth J. Tuman, Louise Newman,

Intraocular Surgery and Lenses

The purpose of this study was to evaluate four pencil-point spinal needles commonly used for combined spinal-epidural (CSE) anesthesia. Four hundred-seven consecutive parturients undergoing cesarean delivery or labor analgesia received a CSE block with a randomly selected pencil-point spinal needle (Becton-Dickinson [B-D] 27-gauge, 119-mm Whitacre; B-D 27-gauge, 120-mm Durasafe[trademark symbol]; B-D 25-gauge, 120-mm Durasafe[trademark symbol]; or International Medical Devices' 26-gauge, 124-mm Gertie Marx[trademark symbol]). Success in obtaining cerebrospinal fluid (CSF) and the incidence of transient paresthesias and postdural puncture headache (PDPH) were compared by using chi squared testing; P < 0.05 was considered significant. Failure to obtain CSF (3%-5%) was not significantly different among spinal needles. The Gertie Marx[trademark symbol] 26-gauge needle was associated with significantly more paresthesias (29%) than the Whitacre 27-gauge needle (17%). The combined incidence of paresthesias with the Durasafe[trademark symbol] 25-gauge and Gertie Marx[trademark symbol] 26-gauge spinal needles (28%) was greater than the combined incidence of paresthesias with the Durasafe[trademark symbol] 27-gauge and Whitacre 27-gauge needles (18%). The incidence of PDPH did not differ among the four pencil-point spinal needles. We conclude that longer spinal needles are associated with a significantly more frequent incidence of transient paresthesias without residual effects. Implications: The use of four pencil-point spinal needles in the combined spinal-epidural technique is associated with an inconsequential incidence of spinal headache, a low incidence of paresthesias that are transient with no long-term effects, and a high degree of success independent of spinal needle length. (Anesth Analg 1998;86:520-2)