Spinal Anaesthesia—The Current Trend towards Narrow Gauge Atraumatic (Pencil Point) Needles. Case Reports and Review

Abstract

Advances in manufacturing technology have led to the wider availability and affordability of narrow gauge atraumatic spinal needles. The use of these needles is the most effective method available for anaesthetists to reduce the incidence of post dural puncture headache. Their use in all circumstances however, may not be appropriate in light of the problems which may be associated. These problems are illustrated here by four case reports and a review of the literature.

The Impact of Spinal Needle Selection on Postdural Puncture Headache

“…These results are likely to have substantial clinical impact as several studies have linked both increased technical difficulty and higher failure rates of spinal anesthesia to smaller-caliber needles. 48,49 As a result, it may be more exacting to select a midgauge (23-to 25-gauge) pencil-point design in order to take advantage of a combination of reduced incidence of PDPH and higher technical proficiency.…”

Post‐Dural Puncture Headache: Part II – Prevention, Management, and Prognosis

“…14 For spinal anesthesia, 25-gauge, 26-gauge, and 27-gauge needles are recommended; needles of 29-gauge or less are associated with high failure rates and are not recommended. 15,16 In children, needle type and size used with spinal anesthesia may be a less important factor as children may be less likely than adults to develop PDPH. 17,18 However, small spinal needles with a size between 25-and 27-gauge are recommended for spinal anesthesia.…”

“…For spinal and epidural anesthesia and myelography, smaller needles are sufficient 14 . For spinal anesthesia, 25‐gauge, 26‐gauge, and 27‐gauge needles are recommended; needles of 29‐gauge or less are associated with high failure rates and are not recommended 15,16 . In children, needle type and size used with spinal anesthesia may be a less important factor as children may be less likely than adults to develop PDPH 17,18 .…”

Morbidity and economic considerations of spinal anaesthesia in the elderly

“…The benefits of small‐gauge, noncutting needles found in younger patients [1, 6, 7] have not been demonstrated in older patients. PDPH in elderly patients may be independent of needle diameter [8] and small‐diameter needles in elderly patients may increase the technical difficulty, possibly resulting in a higher failure rate [9]. Repeated dural punctures have been found to increase headache rate [10].…”