Document Detail


The effect of spinal needle design, size, and penetration angle on dural puncture cerebral spinal fluid loss.
MedLine Citation:
PMID:  17471881     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Postdural puncture headache (PDPH) is a debilitating side effect of spinal anesthesia, the result of dural puncture and cerebrospinal fluid (CSF) leakage with an incidence of 3% to 75% in patient populations. Despite numerous in vitro and in viva studies that have identified predictors associated with PDPH, debate continues on the best technique to reduce CSF leak after dural puncture. The purpose of this in vitro study was to evaluate the relationship between spinal needle type (pencil tipped or cutting), needle size (22 or 25 gauge), and dura penetration angle from perpendicular (90 or 30 degrees), with the resulting CSF leak measured after dural puncture. Spinal needle designs continue to be studied and modified to reduce the incidence of PDPH in identified high-risk groups. For the study, 103 cadaver dura samples were punctured with randomly assigned needles at predetermined angles. The relationship between variables was analyzed. Our results found between needle tip designs a 5-fold increase in mean leak (Quincke > Whitacre) and between needle diameters (25 > 22 gauge), a 6-fold greater mean leakage. Puncture angle demonstrated no significant effect.
Authors:
Glenn O'Connor; Ryan Gingrich; Malini Moffat
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  AANA journal     Volume:  75     ISSN:  0094-6354     ISO Abbreviation:  AANA J     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-05-02     Completed Date:  2007-06-06     Revised Date:  2007-08-03    
Medline Journal Info:
Nlm Unique ID:  0431420     Medline TA:  AANA J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  111-6     Citation Subset:  N    
Affiliation:
University of Detroit Mercy, Michigan, USA. goconno1@hfhs.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Anesthesia, Spinal / adverse effects*,  instrumentation*
Cerebrospinal Fluid / metabolism
Female
Headache / cerebrospinal fluid,  etiology,  prevention & control*
Humans
Male
Middle Aged
Needles*
Nurse Anesthetists*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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