A technique to avoid dural puncture by the epidural catheter

Hughes, J. A.; Oldroyd, G. J.

doi:10.1111/j.1365-2044.1991.tb09818.x

Cited by 11 publications

(3 citation statements)

References 1 publication

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“…Subarachnoid placement of the extradural catheter is a risk with this technique, and occurs in 3 % of procedures at one centre [20]. There are those who advocate turning the needle between subarachnoid injection and catheter insertion [21][22][23] in an attempt to puncture the dura at a site different than that on which the catheter impinges. It should be noted that the force needed to perforate the dura is less if the needle is turned [24] and that turning the extradural needle may cause dural puncture [22,25]; subarachnoid catheterization occurred in three of 77 patients in whom the needle was turned [22].…”

Section: Discussionmentioning

confidence: 99%

Single Space Combined Spinal-Extradural Technique for Analgesia in Labour

Stacey

Watt

Kadim

et al. 1993

British Journal of Anaesthesia

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We have used the single space combined spinal-extradural technique for mothers requesting analgesia in labour. Intrathecal plain bupivacaine 5 mg produced a median time to analgesia of 3 min. There was inadequate abdominal analgesia after 10 min in 16% of recipients, although all had good perineal analgesia. The median height of block was T8 (range T4-L2) and mean duration of analgesia 72 (SD 21) min. Hypotension occurred in two of 30 mothers, but responded to fluids and ephedrine. There were no post-spinal headaches. This technique is suitable for those parturients requesting analgesia in active labour who may not have time to achieve extradural analgesia before delivery. The extradural catheter is used to improve analgesia if the subarachnoid block is inadequate, or if labour continues beyond the duration of the subarachnoid block.

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Section: Discussionmentioning

confidence: 99%

Single Space Combined Spinal-Extradural Technique for Analgesia in Labour

Stacey

Watt

Kadim

et al. 1993

British Journal of Anaesthesia

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“…Needle‐through‐needle CSE via a Tuohy needle theoretically increases the risks of subarachnoid catheter placement as the Huber tip directs the catheter towards the hole made by the spinal needle. Rotation of the Tuohy needle through 180° after spinal placement has been advocated to redirect the epidural catheter away from the dural hole [6, 59, 98, 101–103]. However epiduroscopy shows that Tuohy needles routinely tent the dura after insertion [104] and rotation increases the ease of dural puncture [81], the necessary force reducing as the extent of rotation increases [105].…”

Section: Problems and Complications Of Cse Techniquesmentioning

confidence: 99%

Combined spinal–epidural techniques

Cook

2000

Anaesthesia

163

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SummaryThe combined spinal-epidural technique has been used increasingly over the last decade. Combined spinal-epidural may achieve rapid onset, profound regional blockade with the facility to modify or prolong the block. A variety of techniques and devices have been proposed. The technique cannot be considered simply as an isolated spinal block followed by an isolated epidural block as combining the techniques may alter each block. This review concentrates on technical and procedural aspects of combined spinal-epidural. Needle-through-needle, separate-needle and combined-needle techniques are described and modifications discussed. Failure rates and causes are reviewed. The problems of performing a spinal block before epidural blockade (potential for unrecognised placement of an epidural catheter, inability to detect paraesthesia during epidural placement, difficulty in testing the epidural, delay in positioning the patient) are described and evaluated. Problems of performing spinal block after epidural blockade (risk of catheter or spinal needle damage) are considered. Mechanisms of modification of spinal blockade by subsequent epidural drug administration are discussed. The combined spinal-epidural technique (CSE) involves intentional subarachnoid blockade and epidural catheter placement during the same procedure. CSE allows a rapid onset of neuraxial blockade, which can subsequently be prolonged or modified. Ideally it combines the best features of spinal blockade (rapid onset, profound blockade, low drug dosage) and epidural blockade (titratable levels, ability to prolong indefinitely) and avoids their respective disadvantages (spinal: single-shot nature, unpredictable level of blockade; epidural: missed segments, incomplete motor block, poor sacral spread, local anaesthetic toxicity). However, it is a more complicated technique than either block alone and produces a multicompartment block. This introduces the potential for new complications and the modification of existing complications. CSE cannot be considered as simply a spinal block followed by an epidural block. A variety of techniques, equipment and regimens have been described. New complications and reasons for technical failure are encountered. Epidural injection may modify the spinal block and epidural drugs may not behave as they would without prior dural puncture. Review aims and methodThis review examines the current literature on technical aspects of the CSE technique and factors that distinguish it from either spinal or epidural blockade. The review does not consider different drug regimens or address the role of the technique as analgesia during labour. Owing to the limited number of randomised controlled trials and other high-quality research, the review is descriptive. Articles were found by Medline search through the years 1975-1999 using the search words 'spinal' or 'subarachnoid' and 'epidural' or 'extradural'. Reference lists in these publications were searched. The major anaesthetic journals were hand searched. This search identified 5...

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“…To prevent this problem they rotated the needle 180 0 so that the catheter could be inserted away from the dural hole, as recommended by Hughes and Oldroyd. 12 Unfortunately this resulted in a 20% dural puncture rate and the practice of rotating the epidural needle has now been abandoned in Carter's institution. Interestingly, Hughes and Oldroyd acknowledged that rotation of the Tuohy needle may increase the possibility of dural puncture.…”

Section: Clinicalmentioning

confidence: 99%

“Don't Turn the Needle!”

Duffy

1993

Anaesth Intensive Care

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Accidental dural puncture is a well-recognised complication of epidural anaesthesia. The technique of inserting the epidural needle with the bevel parallel to the spinal ligaments is still taught in some centres. Evidence is presented that the subsequent turning of the needle to allow passage of the epidural catheter may increase the likelihood of dural puncture. There would also appear to be a greater chance of subdural catheterisation. The epidural needle should be introduced with the bevel in the direction in which the catheter is to go and not moved once the epidural space is located.

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A technique to avoid dural puncture by the epidural catheter

Cited by 11 publications

References 1 publication

Single Space Combined Spinal-Extradural Technique for Analgesia in Labour

Single Space Combined Spinal-Extradural Technique for Analgesia in Labour

Combined spinal–epidural techniques

“Don't Turn the Needle!”

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