| Responses to dural puncture during institution of combined spinal-epidural analgesia: a comparison of 27 gauge pencil-point and 27 gauge cutting-edge needles. | |
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MedLine Citation:
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PMID: 21485674 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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Pencil-point spinal needles are popular for combined spinal-epidural analgesia because they cause less dural puncture headache than cutting-edge spinal needles. However many parturients move, grimace, vocalise or experience paraesthesia or dysaesthesia during dural puncture when performing 'needle through needle' combined spinal-epidural analgesia. We compared dural puncture responses induced by pencil-point and cutting-edge needles (both 27 gauge). With institutional approval, 115 parturients presenting for elective caesarean section or labour analgesia were audited. After lignocaine infiltration, a Tuohy-type needle was inserted to loss of resistance to saline at a mid-lumbar interspace, and either a 27 gauge cutting-edge or 27 gauge pencil-point needle was inserted 'needle through needle' through the dura. During dural penetration, the occurrence of patient movement, grimacing or vocalisation was noted by a blinded observer, as was the patient's response to the question "Did you feel that?" asked by the anaesthetist. The audit comprised two similar groups of patients (caesarean section, n=30; labour analgesia, n=85). In both groups, grimacing and movement during thecal penetration occurred more frequently with pencil-point needles (P < 0.05 and P < 0.025, respectively). Pooled data analysis revealed that pencil-point and cutting-edge needles induced grimacing and movement in 17 (22%) and 2 (5%), spontaneous vocalisation in 4 (5%) and 1 (3%) and was perceived by 13 (17%) and 3 (8%) parturients (P < 0.025, P=NS, P=NS), respectively. Overall, 34 and 6 objective and subjective patient responses (P < 0.005) occurred when inserting these needles, respectively. Dural puncture by a 27 gauge pencil-point needle inserted 'needle through needle' when instituting combined spinal-epidural analgesia induces more iatrogenic responses than a 27 gauge cutting-edge needle. |
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Authors:
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A A van den Berg; S Ghatge; G Armendariz; D Cornelius; S Wang |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Anaesthesia and intensive care Volume: 39 ISSN: 0310-057X ISO Abbreviation: Anaesth Intensive Care Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-04-13 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0342017 Medline TA: Anaesth Intensive Care Country: Australia |
Other Details:
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Languages: eng Pagination: 247-51 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology, University of Texas, Houston, Texas, United States of America. antonvdb2000@yahoo.com |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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