Quincke Needle Research Articles

Why don't all individuals who undergo dura mater/arachnoid puncture develop postdural puncture headache?

Why don't all individuals who undergo dura mater/arachnoid puncture develop postdural puncture headache?

Intracranial Subdural Hematoma: a Rare Complication following Spinal Anesthesia: Case Report

Intracranial subdural hematoma is a rare complication following spinal anesthesia. The diagnosis is usually difficult because initial symptoms are the same of post-dural puncture headache. The objective was to report a case of early diagnosed subdural hematoma after spinal anesthesia performed with a fine-gauge needle and single puncture. 48-year old female patient, ASA I, undergoing spinal anesthesia for surgery to correct urinary incontinence. The spinal anesthesia was performed with 27G Quincke needle and single puncture. There was no unexpected event in the surgery and the patient was discharged. After 48 hours of spinal puncture, the patient reported sudden, strong headache, affecting especially the orbital region, but also the temporal region, with important improvement in dorsal decubitus and followed by two vomiting episodes. A cranial tomography was requested and revealed the presence of an acute left frontotemporoparietal subdural hematoma. A conservative treatment with analgesics, dexamethasone and hydantoin was indicated. After 17 days, the patient had intense headache, followed by dormancy and paresis of right upper limb and speech and behavior disorders. The hematoma was surgically drained. The patient evolved well and without sequelae. Headache is the most frequent complication after spinal anesthesia and it is considered of benign evolution. In many cases however, it leads to the late or absent diagnosis of potentially fatal conditions, like subdural hematoma. This case describes a rare case of an acute subdural hematoma following spinal anesthesia with fine-gauge needle in a patient without risk factors for bleeding.

Prevention of hypotension and prolongation of postoperative analgesia in emergency cesarean sections: A randomized study with intrathecal clonidine

Background and Context:Different adjuvants been tried out for neuraxial anesthesia in emergency caesarean section so that the dose of the local anesthetic can be reduced and hypotension thereby prevented.Aims and Objectives:The present study was carried out in patients presenting for emergency lower segment caesarean section (LSCS) to establish the dose of intrathecal clonidine that would allow reduction of the dose of local anesthetic (thereby reducing the incidence and magnitude of hypotension) while at the same time providing clinically relevant prolongation of spinal anesthesia without significant side effects.Materials and Methods:This randomized clinical study was carried out in our institution among 100 pregnant females who underwent emergency caesarean section. The participants were divided randomly into four groups: A, B, C, and D, each comprising 25 parturients. Subarachnoid block was performed using a 26G Quincke needle, with 12 mg of hyperbaric bupivacaine (LA) in group A, 9 mg of LA + 30 μg of clonidine in group B, LA + 37.5 μg of clonidine in group C, and LA + 45 μg of clonidine in group D. The solution was uniformly made up to 2.2 mL with normal saline in all the groups. Onset of analgesia at T10 level, sensory and motor blockade levels, maternal heart rate and blood pressure, neonatal Apgar scores, postoperative block characteristics, and adverse events were looked for and recorded. Statistical analysis was carried out with SPSS® version 10.0 for Windows®, using the ANOVA test with post hoc significance, the Chi-square test, and the Mann-Whitney U test. P<.05 was considered significant and P<.0001 as highly significant.Results:One hundred patients were enrolled for this study. The four groups were comparable with regard to demographic data and neonatal Apgar scores. Onset and establishment of sensory and motor analgesia was significantly shorter in groups C and D, while hypotension (and the use of vasopressors) was significantly higher in groups A and D. Perioperative shivering, nausea, and vomiting were significantly higher in groups A and D, while incidence of dry mouth was significantly higher in group D.Conclusions:The addition of 45 μg, 37.5 μg, and 30 μg of clonidine to hyperbaric bupivacaine results in more prolonged complete and effective analgesia, allowing reduction of up to 18% of the total dose of hyperbaric bupivacaine. From the results of this study, 37.5 μg of clonidine seems to be the optimal dose.

Comparison of two different doses of intrathecal levobupivacaine for transurethral endoscopic surgery.

To evaluate the effects of two different spinal isobaric levobupivacaine doses on spinal anesthesia characteristics and to find the minimum effective dose for surgery in patients undergoing transurethral resection (TUR) surgery. Fifty male patients undergoing TUR surgery were included in the study and were randomized into two equal groups: Group LB10 (n=25): 10 mg 0.5% isobaric levobupivacaine (2 ml) and Group LB15 (n=25): 15 mg 0.75% isobaric levobupivacaine (2 ml). Spinal anesthesia was administered via a 25G Quincke spinal needle through the L3-4 intervertebral space. Sensorial block levels were evaluated using the 'pin-prick test', and motor block levels were evaluated using the 'Bromage scale'. The sensorial and motor block characteristics of patients during intraoperative and postoperative periods and recovery time from spinal anesthesia were evaluated. In three cases in the Group LB10, sensorial block did not reach the T10 level. Complete motor block (Bromage=3) did not occur in eight cases in the Group LB10 and in five cases in the Group LB15. The highest sensorial dermatomal level detected was higher in Group LB15. In Group LB15, sensorial block initial time and the time of complete motor block occurrence were significantly shorter than Group LB10. Hypotension was observed in one case in Group LB15. No significant difference between groups was detected in two segments of regression times: the time to S2 regression and complete sensorial block regression time. Complete motor block regression time was significantly longer in Group LB15 than in Group LB10 (p<0.01). Our findings showed that the minimum effective spinal isobaric levobupivacaine dose was 10 mg for TUR surgery.

Comparison of post-dural puncture headache and low back pain between 23 and 25 gauge Quincke spinal needles in patients over 60 years: Randomized, double-blind controlled trial

Background Even though the use of a 25 gauge or smaller Quincke needle is recommended for spinal anesthesia to reduce post-dural puncture headache in Korea, lumbar puncture in older patients using a 25 gauge or smaller Quincke needle can be difficult. However, most previous studies concerning post-dural puncture headache have chosen children, parturients, and young adults as study participants. Objectives The study compared post-dural puncture headache, post-operative back pain, and the number of lumbar puncture attempts using a 23 or 25 gauge Quincke needle for spinal anesthesia of Korean patients >60-years-of-age. Design Randomized, double-blinded controlled trial. Participants The 53 participants who underwent orthopedic surgery under spinal anesthesia were recruited by informed notices from December 2006 through August 2007 at a 200-bed general hospital located in Kyunggido. Inclusion criteria were an age >60 years, ASA I–II, and administration of patient controlled analgesia for the first 48 h post-operatively. Methods The 53 patients were randomly allocated to either the experimental (23 gauge Quincke needle) or control group (25 gauge Quincke needle). All patients had 24 h bed rest post-operatively. Post-dural puncture headache was assessed by the Dittmann Scale and post-operative back pain was assessed by a visual analogue scale at 24, 48, and 72 h post-operatively. The statistical methods included the Mann–Whitney U-test and Spearman correlation. Results There were no differences in post-dural puncture headache, and post-operative back pain at 24, 48, and 72 h post-operatively, and no differences in the number of lumbar punctures, with the 23 and 25 gauge Quincke needle. Forty-eight hour post-operative back pain was positively associated with the number of lumbar punctures ( p = .036) and age ( p = .040). There were no statistically significant associations among post-dural puncture headache, the number of lumbar punctures, and 48 h post-operative back pain. Pre-operative back pain was positively associated with 48 h post-operative back pain ( p < .001). Conclusions The choice of a 23 or 25 gauge Quincke needle for spinal anesthesia has no significant influence on post-dural puncture headache and post-operative back pain for Korean patients greater than 60-years-of-age. The 23 gauge Quincke needle is an option for lumbar punctures in this patient population.

Acute spinal subarachnoid haematoma following spinal anaesthesia treated conservatively: case report

Acute spinal subarachnoid haematoma following spinal anaesthesia treated conservatively: case report

Morphologic Study of Nerve Root and Types of Needle Used in Transforaminal Injections

The bevel type and location of the distal orifice of the needle may have relevance for potential complications occurring during transforaminal epidural injection. We examined by scanning electron microscopy the structural aspects of spinal nerve root cuffs of 3 human cadavers, and 3 needle types used in transforaminal injections: 22-gauge Quincke spinal needles, 22-gauge blunt nerve block needles, and 20-gauge radiofrequency blunt needles. We made punctures in vitro in the spinal nerve root cuffs, and we studied the structures affected. There is fat tissue within the nerve root with irregular distribution. In needles with a round tip, the distal orifice maintained an extraneural location after puncture of the nerve root cuff. The length of the needle required to introduce the distal orifice completely inside the nerve root cuff was variable, depending on the type: shortest for a Quincke needle (1.8 mm), 4.1 mm for the Epimed, and longest for radiofrequency needles (5.7 mm). The layer of fat around nerve roots may prevent the contact of the needle tip with axons. The sharp needle tip entered the nerve root cuff more easily than the blunt tip in the cadaveric nerve root samples, measured in a qualitative manner. There is a need for clinical studies to ascertain if blunt needles may be safer than sharp needles for transforaminal injections.

Needle‐through‐Quincke needle technique for establishing spinal anaesthesia in the obese patient

We would like to report a novel needle-through-Quincke needle technique for assisting the establishment of spinal anaesthesia in the obese patient that two of the authors have used as their standard for obese patients in obstetric and orthopaedic settings for several years. Difficulties in successfully establishing subarachnoid anaesthesia often occur with obese patients and these can be further compounded during pregnancy by additional weight gain, oedema and problems with optimal positioning. The use of ultrasound to localise the spinal anatomy, including location of the interspinous spaces and the depth of the epidural space, has been well documented [1, 2], as has the use of an epidural needle as an introducer for long spinal needles [3]. We use ultrasound to locate a suitable space and to measure the depth of the dura. We mark the space as a needle insertion point. We then insert a 9-cm 20-G Quincke spinal needle (Becton Dickinson, Franklin Lakes, NJ, USA) through the marked point to a depth some 2–3 cm short of the dura, as measured by ultrasound. We then pass a 12-cm 24-G Sprotte needle (Pajunk, Geisingen, Germany), through the ligamentum flavum and dura into the cerebrospinal fluid (CSF). Should CSF not be visible within the Sprotte needle, we advance both needles together until successful dural puncture occurs. Should ultrasound be unavailable or unhelpful in identifying the space, we employ a blind approach. We insert the Quincke needle into the interspinous ligaments and then pass the long Sprotte needle through the Quincke needle, to project beyond the end of the latter. We can then advance the two needles together, with the atraumatic tip of the Sprotte needle acting as the leading point. We believe our technique avoids some of the potential problems of using a Tuohy needle as a spinal introducer, in particular, the inability to pass the spinal needle through the Huber tip, the deflection of the spinal needle by the Huber tip, the ‘dry tap’ that can occur after successful localisation of the epidural space [4], and a significantly smaller breech to the dura should accidental puncture occur with the Quincke needle. Dural puncture is extremely unlikely, as the leading point is that of the Sprotte needle. The Quincke needle is sufficiently stiff to allow easy placement even in very obese patients. We believe that ultrasound localisation adds to the accuracy of the technique, by providing accurate anatomical information of depth and the required angle of needle insertion. No external funding and no competing interests declared.

Incidence of post dural puncture headache following Caesarean section under spinal anaesthesia at the Aga Khan University Hospital, Nairobi

Post dural puncture headache can be a debilitating complication of subarachnoid anaesthesia for a new mother. Successful management of post dural puncture headache requires adherence to clear policies and protocols with close follow up of patients by an experienced obstetric anaesthetist. To examine the cumulative incidence and severity of post dural puncture headache in obstetric patients who consented for spinal anaesthesia for Caesarean section. Prospective cohort study. All women who underwent Caesarean sections under spinal anaesthesia and fulfilled the inclusion criteria. Aga Khan University Hospital, a teaching and referral hospital in Nairobi, Kenya. The overall cumulative incidence of post dural puncture headache was found to be 20.35 % but was significantly higher in patients in whom the quincke type of needle was used than in those whose spinal anaesthetics were administered using the pencil point needle (24.2% and 4.5% respectively: p=0.042). The incidence of post dural puncture headache can be significantly reduced in the obstetric population at the Aga Khan University Hospital if the pencil point spinal needle was to be routinely used. We recommend that the Quincke needles should not be used in the obstetric population at the Aga Khan University Hospital.

Do pencil-point spinal needles decrease the incidence of postdural puncture headache in reality? A comparative study between pencil-point 25G Whitacre and cutting-beveled 25G Quincke spinal needles in 320 obstetric patients.

Background:Postdural puncture headache (PDPH) is a distressing complication of the subarachnoid block. The previous studies conducted, including the recent ones, do not conclusively prove that pencil-point spinal needles decrease the incidence of PDPH. In this study, we have tried to find out whether a pencil-point Whitacre needle is a better alternative than the classic cutting beveled, commonly used, Quincke spinal needle, in patients at risk of PDPH.Materials and Methods:Three hundred and twenty obstetric patients, 20-36 years of age, ASA I and II, posted for Cesarean section under subarachnoid block, were randomly assigned into two groups W and Q, where 25G Whitacre and 25G Quincke spinal needles were used, respectively. The primary objective of the study was to find out the difference in incidence of PDPH, if any, between the two groups, by using the t test and Chi square test.Results:The incidence of PDPH was 5% in group W and 28.12% in group Q, and the difference in incidence was statistically significant (P<0.001).Conclusion:The pencil-point 25G Whitacre spinal needle causes less incidence of PDPH compared to the classic 25G Quincke needle, and is recommended for use in patients at risk of PDPH.

Evaluation of spinal and epidural anaesthesia for day care surgery in lower limb and inguinoscrotal region

Day care surgery is still in its infancy in India. Both regional and general anaesthesia can be used for this. Central neuraxial blocks are simple cheap and easy to perform. This study was done to evaluate usefulness of spinal and epidural anaesthesia for day care surgery. PATIENTS #ENTITYSTARTX00026; 100 patients were randomized to either spinal (n=50) or epidural (n=50) group anaesthetized with either 0.5% hyperbaric 2ml bupivacaine or 0.5% 20ml bupivacaine respectively. In spinal group 27 gauze quincke needle and in epidural group 18 gazue tuohy needle was used. Both the groups were compared for haemodynamic stability, side effects, complications, postanaesthesia discharge score (PADS), time taken to micturate, total duration of stay in hospital and patient satisfaction score for technique. We observed that spinal anaesthesia had significantly early onset of anaesthesia and better muscle relaxation (p<0.05) as compared to epidural block otherwise both groups were comparable for haemodynamic stability, side effects or complications. Although more patients in spinal group (64% vs 48%) achieved PADS earlier (in 4-8 hours) but statistically it was insignificant. Time to micturition (6.02 0.55 v/s 6.03 0.47 hours) and total duration of stay (7.49 1.36 v/s 8.03 1.33 hours) were comparable in both the groups. Both spinal and epidural anaesthesia can be used for day care surgery. Spinal anaesthesia with 27 gauze quincke needle and 2ml 0.5% hyperbaric bupivacaine provides added advantage of early onset and complete relaxation.

Role of repeated epidural injections in preventing post-spinal hearing loss

Study Objective To determine if epidural volume extension and continued postoperative epidural injections prevent hearing loss associated with a 23-gauge (G) Quincke spinal needle. Design Prospective, double blinded trial. Setting Operating rooms. Patients 30 adult patients scheduled for lower abdominal or perineal surgery during spinal anesthesia. Interventions Patients were divided into two groups of 15 each. All patients received subarachnoid injection with a 23-G Quincke needle. While patients in Group S received a single-shot spinal, Group E patients underwent epidural catheter placement one intervertebral space above. The epidural catheter was bolused with 10 mL of normal saline followed by postoperative epidural boluses of local anesthetic for analgesia as needed. Measurements Patients’ auditory function was evaluated by pure tone audiometry (frequencies of 250-8,000 Hz) on the day before and two days after receiving the spinal anesthesia. Main Results Unilateral low-frequency hearing loss (500 Hz) was seen in Group S ( P < 0.05). It was prevented by the repeated epidural injections as used in Group E. Conclusion Following spinal anesthesia, epidural volume extension with 10 mL of normal saline followed by epidural local anesthetic boluses titrated to adequate postoperative analgesia (6-8 mL each time) prevents post-spinal hearing loss.

Effects of spinal needle size on hearing functions in endoscopic urological operations

Abstract Aim. The aim of this study was to determine whether any hearing loss occurs in the patients who undergo endoscopic urological operations after spinal anesthesia and to investigate whether the size of the needle affects the risk of this complication. Methods. The study was approved by ethical committee and informed consent was obtained from all patients. 30 patients were divided into 2 groups randomly. Spinal anesthesia was performed via L3-4 or L4-5 interspaces with 10 mg 0.5% hyperbaric bupivacaine by using 22 G Quincke needle in Group I patients, and by 26 G Quincke needle in Group II patients. Pure Tone Audiometry and plasma osmolarity calculation of venous blood were done preoperatively and at the 48th hour postoperatively. Systolic blood pressure, diastolic blood pressure, heart rate were recorded with 5 minutes intervals intraoperatively and for 12 hours postoperatively. The patients were evaluated about headache and the other side effects postoperatively. Results. There were no differences between groups about demographic data, hemodynamic parameters and plasma osmolarity (p>0.05). Subclinical hearing loss was observed in 10 patients of Group I (66.6 %) and in 4 patients of Group II (26.6 %). The rate of hearing loss in Group I was statistically higher than in Group II (p 0,05). Grup I'de 10 hastada (%66,6), Grup II'de 4 hastada (%26,6) subklinik isitme kaybi gozlendi. Grup I'deki isitme kaybi Grup II'ye gore istatistiksel olarak daha fazlaydi ( p<0.05). Grup I'de 7 hastada, Grup II'de 2 hastada bas agrisi gelisti. Sonuc. Sonuc olarak, genis capli spinal ignelerle olusan dural yirtigin ve BOS sizintisinin isitme kaybini ve bas agrisini artirdigi kanisina varildi. Anahtar sozcukler: Spinal anestezi, spinal igne capi, postspinal isitme kaybi, odyometri

Spinal anaesthesia in young patients: evaluation of needle gauge and design on technical problems and postdural puncture headache

AbstractBackground: The well-known complication of spinal anaesthesia, postdural puncture headache (PDPH), is especially troublesome in young patients. The needle gauge and configuration of needle tip appear to be the important factors in reducing the incidence of PDPH; however it may increase the incidence of technical problems.Objective: To evaluate the role of 25 and 27 gauge Quincke and Whitacre spinal needles on technical difficulties and incidence of PDPH in patients between 16 and 40 years of age.Methods: Eight hundred patients receiving spinal anaesthesia for urological surgery were divided into four groups of 200 each according to spinal needle used. Group Q-25 and group Q-27 received spinal anaesthesia with 25 gauge and 27 gauge Quincke needles whereas in group W-25 and group W-27, 25 gauge and 27 gauge Whitacre needles were used. The parameters observed were technical problems in terms of number of attempts, failure rate, time to cerebrospinal fluid (CSF) detection and incidence and severity of...

Osteogenesis Imperfecta in Pregnancy. Case Report

Osteogenesis Imperfecta is a rare condition, especially in obstetric patients. It has an estimated prevalence of 1/10,000 in the general population, and 1/25,000 to 30,000 in obstetric patients. The objective of this report was to present a rare case of a pregnant woman with Osteogenesis Imperfecta undergoing cesarean section. This is a 23 years old gravida on the 38th week, admitted to the maternity ward with loss of amniotic fluid and contractions for four hours, associated with the absence of fetal movements for four days. The patient had a mild form of Osteogenesis Imperfecta without other comorbidities. She was not taking any medication, and she did not have prenatal follow-up. The patient underwent spinal anesthesia in the L(3)-L(4) space, median approach, with a single puncture with a 27G Quincke needle and the administration of hyperbaric 0.5% bupivacaine (10 mg) and morphine (60 microg). She was discharged in the second postoperative day without complaints. Fertility is preserved, especially in those patients with type I of the disease, and pregnancy can be carried to term. Delivery is usually surgical due to pelvic deformities in the gravida, cephalopelvic disproportion, and increased incidence of abnormal fetal presentation. The importance of the anesthesiologist in the surgical team relies on the perioperative management and the choice of the most appropriate anesthetic technique for each patient.

Magnesium sulfate infusion prevents shivering during transurethral prostatectomy with spinal anesthesia: a randomized, double-blinded, controlled study

Study Objective To determine whether magnesium sulfate (MgSO 4) infusion during surgery reduces shivering during spinal anesthesia. Design Double-blinded placebo-controlled, randomized trial. Setting Operation room of a university hospital. Patients 60 patients, aged 40 to 70 years, scheduled for elective transurethral resection of the prostate (TURP) during spinal anesthesia. Interventions Subarachnoid anesthesia consisting of hyperbaric bupivacaine three mL 0.5% was injected using a 25-G Quincke spinal needle. Patients received either saline (Group C, n = 30) or MgSO 4 (Group Mg, n = 30). Group Mg received an intravenous (IV) bolus of MgSO 4 80 mg/kg via syringe pump over a 30-minute period, followed by a two g/hr infusion during the intraoperative period. Group C received an equal volume of saline. Measurements Motor blockade was evaluated by Bromage motor scale. Sensory block level was assessed by pinprick test. Shivering was assessed after the completion of subarachnoid drug injection. Side effects were recorded. Main Results Hypothermia was observed in all patients (100%) in Group Mg and in 24 patients (80%) in Group C ( P = 0.024). The decrease in core temperature in Group Mg was significantly greater ( P < 0.005). Shivering was observed in two patients (6.7%) in Group Mg and 20 patients (66.7%) in Group C ( P = 0.0001). Conclusions MgSO 4 infusion in the perioperative period significantly reduced shivering during TURP with spinal anesthesia. MgSO 4 infusion prevents shivering in patients receiving spinal anesthesia but increases the risk of hypothermia.

High incidence of post-dural puncture headache in patients with spinal saddle block induced with Quincke needles for anorectal surgery: a randomised clinical trial

Spinal saddle block represents nearly the ideal anaesthesia technique for anorectal surgery. Post-dural puncture headache (PDPH) is a dreaded complication but can be decreased by the use of non-cutting spinal needles to rates less than 1%. Though, cutting Quincke type needles are still widely used for economic reasons, leading to a higher rate of PDPH. We performed this study to demonstrate a reduction of PDPH by the use of very small 29-G compared with commonly used 25-G Quincke type spinal needles. Two hundred sixteen adult patients (male/female, 19-83 years, ASA status I-III) were randomised 1:1 to groups, in which either a 25-G or a 29-G Quincke type spinal needle was used for a spinal saddle block. The incidence of PDPH was assessed during 1 week after surgery. Thirty-nine of 216 patients developed PDPH but there was no difference between the two needle sizes (25-G, n = 18/106 vs. 29-G, n = 21/110, p = 0.6870). Women suffered significantly more from PDPH than men (23/86 vs. 16/130, p = 0.0069). Ambulatory patients had a later onset of PDPH than in-patients (24 h [0.5-72] vs. 2 h [0.2-96], p = 0.0002) and the headache was more severe in these patients (NRS 7 [2-10] vs. NRS 3 [1-8], p = 0.0009). The use of 29-G compared with 25-G Quincke needles led to no reduction of PDPH and is considerably higher compared with data from pencil-point needles. The use of non-cutting or pencil-point spinal needles should become the standard for performing spinal saddle block.

Electron microscopy evaluation of block needle-related trauma to the tibial nerve

Direct puncture by a needle is a risk factor for nerve damage. This investigation used scanning electron microscopy (SEM) to attempt to visualize the damage caused by different needles. A 15 cm section of the tibial nerve was removed from the ankle of a patient undergoing below-the-knee amputation. The nerve specimen was punctured perpendicular to the fibers once by each of four needles: an insulated 22 G short-beveled (30 degrees), a 25 G long-beveled Quincke spinal needle, an 18 G Tuohy, and a 25 G Whitacre pencil point. The distal and proximal ends on either side of the needles were marked and the nerve was sectioned into 0.5 cm pieces. Each sample was preserved and then prepared for SEM. The needle tract was observed for evidence of mechanical damage at magnifications between x 47 and x 102 using SEM. The epineurium, perineurium, fascicles, endoneurium, and vessels were identified in each sample. In both the short-beveled and the Whitacre samples, all fascicles along with the surrounding perineurium were intact. In both the Tuohy and the Quincke samples, obvious transection of fascicles and disruption of the perineurium were observed. This investigation suggests that both the Tuohy and the Quincke needles may be more likely to cause trauma to the tibial nerve than either the short-beveled or the Whitacre needles.

Evaluation of Tip Holed Spinal Needle - A Comparative Study

Background: The performance and post dural puncture headache were assessed in this randomised clinical study. Methods. Total 100 patients of ASA physical status I and II undergoing elective caesarean section were enrolled for the study. Patients in the controlled group Group-A. Patients in the trial group (Group-B). ABSTRACT: Regional block has its own unique place in modem anesthetic practice increasing popularity over 30-40 years has followed better understanding of the technique and acceptance than the incidence of side effects is tow. These depend not only on the correctly performed procedures but the correct design of the needle is also important. The purpose of this clinical study is to evaluate the performance of tip hole spinal needle (25G) in comparison with widely used Quincke spinal needle (25G). Clinical effects, performers satisfaction, side effects and complications were assessed over 100 pts who were decided into group A (Qiuncke gr) &amp; Group B (tip hole gr) undergoing emergency &amp; elective C.S. under spinal anaesthesia. Ease of insertion of the needle, number of attempts for successful insertion, appearance of CSF flow through needle, bending of needle, quality of analgesia, clinical effects &amp; PDPH were assessed. No significant changes in pulce, BP. &amp; SPO2 in 1 minute &amp; 5 minuets were found in pre-operative &amp; per-operative period in Group A &amp; also in Group B. In terms of ease of insertion there was no significant change in Group A (100%) &amp; Group B (90%). It was found that in less than 1 second no CSF fluid appeard in Group A but in Group B, CSF appeard in 30%, in less than 2 seconds, the values among Gr A &amp; Gr B were 4% &amp; 52%, in less than 3 seconds. 50% &amp; 18% respectively. In less than 4 seconds &amp; 5 seconds in Group A 38% &amp; 8% respectively and no CSF fluid appeard in Group B in that period. In Group A 52% cases required 1 attempt, 28% cases 2 attempts, 16% of cases 3 attempts &amp; 4% cases 4 attempts were required. In Group B it was 86%, 14% &amp; no 3rd &amp; 4th attempts required. In terms of bending of needles during insertion, the performance of Group B was better (7% in Group A and no in Group B). The incidence of PDPH was found absolutely nil among the gr B &amp; negligible (2%) in gr A subjects. Journal of BSA, Vol. 18, No. 1 &amp; 2, 2005 p.3-8

Effect of Site of Injection on Spread of Spinal Anaesthesia with Hyperbaric Bupivacaine

Ninety unpremeditated patients (20-40 years) undergoing caesarean section were allocated randomly to receive 0.5% hyperbaric bupivacaine 2ml at the site of L2-3, L3-4 and L4-5 intervertebral space. Spinal injection was performed to all patients with a 25-gauge Quincke spinal needle. The onset time of analgesia at T10 and T6 was significantly faster and the level of analgesia at 5 and 10 min was significantly higher after injection at L2-3. But the maximum height (T4) of analgesia at 15 and 20 min after injection and the number of episodes of hypotension were not significantly different among the three groups. Key words: Spinal anaesthesia, hyperbaric bupivacaine, site of injection, spread of anaesthesia. Journal of BSA, Vol. 20, No. 2, July 2007 p.51-55