The effect of changing pressures on dural puncture and leak with various spinal needles on an in vitro model

Abstract

Postdural puncture headache is one of the most serious complications of spinal anesthesia. In this study, spinal needles of various types and shapes were used to investigate the amount of fluid leakage in dural puncture under various levels of pressures. Dura samples received from 10 cadavers were fixed in an in vitro model. The dural punctures were inflicted with 22 G, 25 G, and 27 G Quincke; 25 G Withacre; 25 G, 27 G Pencan, and 26 G Atraucan spinal needles. The fluid, which leaked during the process, was collected under the pressures of 0, 25, 50, 100, and 150cm H2O in one-hour period for each level. The holes in the dura were studied under light microscope. While 22 G and 25 G Quincke needles were used, the fluid leakage directly correlated the amount of liquid, the diameter of the needle, and the pressure used. The puncture of 25 G Withacre and 25 G Pencan presented a leakage which did not significantly vary with the liquid pressure and was of lesser amount. In 26 G Atraucan, 27 G Pencan, and 27 G Quincke inflicted punctures, little liquid was collected and it did not vary with differing pressures. Thus, no significant correlation was established between the needle diameter and the puncture.It was concluded that the sharp-ended needles could not endure changes in the pressure. However, those needles with a very thin diameter and a pencil tip were considered as safe tools for anesthetical practices.