Neuraxial needles

Dr. S. Parthasarathy MD, DA, DNB, Dip Diab.MD ,DCA, Dip software

based statistics,PhD (physiology) FICA

Some history

• The first spinal anesthetic was administered• accidentally by J. Leonard Corning• Experimenting with cocaine on spinal nerves

of a dog, accidentally breached dura between two lumbar vertebra, causing paralysis of the hind limbs -

• inadvertently performed the first spinal anesthesia

Corning

• It was made of a flexible material, with an introducer

and a limiter to keep the equipment fixed whilst

approaching to the subarachnoid space. The tip of the

needle consisted of a short and sharp bevel, based on

the hypodermic needle by Alexander Wood

Quincke needle

• Sharp bevel • Let down CSF in increased ICT

• The Bier spinal needle• 15G or 17G, • long, cutting bevel• sharp point.• No introducer

Bainbridge Needle (1900)

• Short cutting bevel • Small circular hub • Stylet

Barker Needle (1907)

• Sharp,medium-length bevel• a stylet• matching bevel

• Hard nickel

Quincke babcock needle(1914)

• William Wayne Babcock described a needle in 1914 that was similar to the original Corning needle but had a smaller caliber (20 gauge).

• It was made of platinum or gold and also known as Quincke-Babcock needle.

Labat (1921)

• Nickel • Short bevel • Push instead of cutting concept • Later – the concept was used for pencil point

Hoyt (1922)• set of needles for spinal puncture.

• The external, which served as an usher, was used to

penetrate tissue and ligaments to the vicinity of the

dura mater Then a thinner needle was inserted inside

to penetrate the duraIntroducer

sets – forerunner

Greene

• Blunt needles • smaller diameter hole resulted from the use of

blunt needles compared to those with sharp edges

Helbert or barnett greene –

fight ??

Pitkin needle

• short bevel with an angle of approximately 45 degrees from the longer stem to the shorter.

• Better feel • Creates Dural flap which closes !! Paramedian

approach concept

William T Lemmon• continuous spinal anesthesia. • malleable alloy of nickel/silver and used with an

introducer. • It had a short and sharp bevel and a lateral hole to

facilitate a free flow of CSF • After the puncture, was folded and fixed on the skin

surface and connected to a rubber tube through which local anesthetic was administered if needed.

• Finally, the patient had to be positioned on a surgical table mattress with a hole in which the needle protruding dorsal could be adequately accommodated.

Lemon mattress

So many Others • Sise • Kirschner• Hingson• Rovenstine• Cappe & Deutsch• Brace• Levy • Cheng

So many !!

Stylet or introducer

• Needle • Introducer • Stylet – other wise tissue coring and block of

needle

• If introducer , stylet use ??

Touhy !!

• Huber developed a tip for hypodermic needles with

long, sharp, and fundamentally curved bevel– to

decrease tissue damage for routine injection

• Touhy used it to thread ureteral catheters to spinal

and epidural

• Direction !! huber

Whitacre

• point described as "resembling a sharpened pencil" and a distal side orifice next to it.

• This description became popular and called these conical tip needles: “pencil point needles”.

Ball pen needles !!

Whitacre

• Flow of CSF and spinal injection ?? • Whitacre needle is one of the most currently used for

spinal and advocated, by many authors, for use in obstetric patients.

Rough metallic edges of pencil point needles

Crawford (1951)

• extremely short and, thereby, little sharp bevel. • mainly for thoracic punctures, • hanging drop technique. • 677 thoracic surgeries.

No Huber tip

Hustead• More blunt • More angulated• Insertion of catheter – yes • Shearing – less • Dural puncture less •

Weiss

• Short bevel • Two flaps • Hanging drop easy

Lutz

• Single dose epidural • Blunt tip• No catheter – unpopular

Hanoaka

• Touhy huber • Needle through needle• Back hole

Common !!

Double lumen epidural needle

• CSEA • Coomb s

Sprotte

• Modifications to whitacre • an elongated tip in an attempt to promote a

more gradual separation of the dural fibers,, • lateral orifice larger and oval to CSF flow• Anaesthetic deposition better

• BUT ??

Sprotte

Quincke – local

anesthetic spread ??

Comparison

Atraucan

• characteristic tip with two rows of sharp bevels. • most sharp tip promotes the initial incision in the

tissues and in the dura mater, • second part of the bevel enlarges the hole. • thinnest and relatively fragile tip which may fracture

during the puncture.

Single bony contact – atraucan needle

LEE needle

What we use Removable flange

Episure

• Specifically engineered internal compression spring which applies a precise force on the plunger, regardless of the amount of saline drawn into the syringe

• Plunger automatically depresses when the needle enters the Epidural Space

• Plunger has extremely low friction coefficient and moves very smoothly

Epidural needles are made of ?? • Iron 69 % • Chromium – 18 % • Nickel – 9 % • Manganese – 1.5% • Silicon + molybdenum – traces

Dural hole

• 22 g needle 29 G needle

Pearls • Originally thought - pencil point needles cause less

dural trauma • But no --- • They cause more edema more inflammation to seal

the hole to cause less PDPH • pencil-point needles caused two to three times less

fluid loss than the Quincke beveled needles. (1 hour let off)

The outer diameter of same 25 G needles may vary – the force for the puncture of the dura different !!

Summary

• Quincke , greene, sprotte , atraucan • Crawford • Touhy • Lee needles

• Pros and cons

Thank you all