The PENCAN 25-gauge needle: A new pencil-point needle for spinal anesthesia tested in 1,193 patients

Krommendijk, E.; Verheijen, R.; Dijk, Bob van; Spoelder, E. M.; Gielen, M.J.M.; Lange, J.J. de

doi:10.1016/s1098-7339(99)90164-5

Cited by 15 publications

(15 citation statements)

References 19 publications

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“…Nevertheless, all paresthesia was transient and without a residual sequel. Both results are consistent with the observations from other studies [17,18]. A higher rate of bloodstained CSF in the paramedian compared to the midline approach was not determined in this study, which does not correlate with our initial hypothesis.…”

Section: Discussionsupporting

confidence: 89%

“…Even if paresthesia occurs during needle insertion, it is transient [17]. A high rate of dural click perceived upon dural puncture with Sprotte needles has been demonstrated, a fact described as a technical advantage of these needles [18]. The risk of obtaining blood-stained CSF is thought to be higher when using the paramedian approach due to the fact that the paramedian plane is more vascularized compared to the midline plane.…”

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confidence: 99%

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Impact of spinal needle design and approach to postdural puncture headache and spinal anesthesia failure in obstetrics

Batova¹,

Georgiev²

2019

ait

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Obstetric patients have a higher incidence of postdural puncture headache (PDPH) than the corresponding incidence in the general population. Current evidence suggests that pencil-point spinal needles are significantly superior compared to cutting spinal needles regarding the frequency of PDPH [1,2]. Moreover, the impact of needle gauge on PDPH has been shown to be less important in pencil-point as compared to cutting needles [3]. Atraucan is a double-beveled needle containing cutting and blunt components of the bevel. It was categorized as a non-traumatic needle in a recent meta-analysis [1] but its place regarding PDPH is not fully elucidated. Introducing cutting needles with the bevel parallel to the longitudinal dural fibers is found to be a factor associated with reduction of the incidence of PDPH [4].The notion that the paramedian approach decreases the incidence of PDPH is supported by studies in models of the dura mater in vitro showing that the oblique angle of dural puncture causes less leakage across the dura [5,6]. Clinical studies regarding the influence of the paramedian approach on PDPH have shown contradictory results.The association between the patient's position during lumbar puncture and PDPH was the object of Abstract Background: Concern has been raised that Sprotte needles predispose to spinal anes thesia failure. Nevertheless, these needles are associated with a low incidence of post dural puncture headache. The impact of the paramedian approach to postdural punc ture headache remains controversial. The objective of this prospective randomized study was to compare Sprotte, Quincke and Atraucan needles as well as the midline and the paramedian approach in terms of postdural puncture headache and spinal anesthesia failure in patients undergoing Caesarean section.Methods: 655 patients were randomized to 5 groups. A midline approach was used in four groups. The spinal needles were the 25G Sprotte, 27G Sprotte, 26G Atraucan and 25G Quincke. In the fifth group a 25G Quincke needle was used by the paramedian approach.Results: The incidence of postdural puncture headache was 0% in both 25G and 27G Sprotte groups, 2.5% in the 26G Atraucan group, and 7.2% and 2.7% in the 25G Quincke midline and paramedian approach respectively. A significant difference in terms of post dural puncture headache was found between 25G Sprotte and 25G Quincke needles (P = 0.004), while the failure rate was similar between these two needles. A significant difference in spinal anesthesia failure rate was observed between midline and parame dian approaches (P = 0.041).Conclusions: Sprotte but not Atraucan needle design correlates with lower incidence of postdural puncture headache compared to Quincke design. Sprotte needles are not associated with a higher spinal anesthesia failure compared to Quincke needles. The incidence of postdural puncture headache by the paramedian approach is not sig nificantly reduced whereas the spinal anesthesia failure rate is increased in comparison to the midline approach.

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Section: Discussionsupporting

confidence: 89%

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confidence: 99%

Impact of spinal needle design and approach to postdural puncture headache and spinal anesthesia failure in obstetrics

Batova¹,

Georgiev²

2019

ait

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“…According to literature, the incidence of failed or partially failed SpA ranges between 0.5 and 17% [3–5]. The incidence of postdural puncture headaches (PDPHs) ranges between 0,7 and 11% based on the type of needle used [6, 7], and transient neurologic syndromes can still be observed after SpA with an incidence of 0–7% [8]. …”

Section: Introductionmentioning

confidence: 99%

Procedural Complications of Spinal Anaesthesia in the Obese Patient

Wenk

Weiß

Möllmann

et al. 2012

Anesthesiology Research and Practice

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Background. Complications of spinal anaesthesia (SpA) range between 1 and 17%. Habitus and operator experience may play a pivotal role, but only sparse data is available to substantiate this claim. Methods. 161 patients were prospectively enrolled. Data such as spread of block, duration of puncture, number of trials, any complication, operator experience, haemodynamic parameters, was recorded and anatomical patient habitus assessed. Results. Data from 154 patients were analyzed. Success rate of SpA in the group of young trainees was 72% versus 100% in the group of consultants. Trainees succeeded in patients with a normal habitus in 83.3% of cases versus 41.3% when patients had a difficult anatomy (P = 0.02). SpA in obese patients (BMI ≥ 32) was associated with a significantly longer duration of puncture, an increased failure ratio when performed by trainees (almost 50%), and an increased number of bloody punctures. Discussion. Habitus plays a pivotal role for SpA efficiency. In patients with obscured landmarks, failure ratio in unexperienced operators is high. Hence, patient prescreening as well as adequate choice of operators may be beneficial for the success rate of SpA and contribute to less complications and better patient and trainee satisfaction.

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“…15 However, similar gauge needles do not always ensure the same CSF flow rate. 16,17 A major contributing factor to CSF flow rate is internal diameter, which for any given needle size varies between manufacturers.…”

Section: Discussionmentioning

confidence: 99%

“…16,17 A major contributing factor to CSF flow rate is internal diameter, which for any given needle size varies between manufacturers. 15 When patient posture during needle placement remains the same, ease of CSF flashback depends on several factors, including the cross-sectional area of the CSF entry orifice, the actual availability of this orifice in clinical settings where it may be obstructed to a varying degree by the dural fibers, 3 the internal diameter of the needle shaft, and the length of the needle. Among these factors, the internal diameter of the needle shaft likely plays the major role.…”

Section: Discussionmentioning

confidence: 99%

Tip-holed spinal needle: A new design concept

Jahangir¹

2000

Regional Anesthesia and Pain Medicine

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Dura-arachnoid puncture for spinal anesthesia is associated with several complications. Postdural puncture headache (PDPH) and needle bending are significant among these. The incidence of PDPH has been reduced significantly with the advent of pencil-point needles. However, these needles also have their limitations, such as obstruction of the delivery port by tissues affecting both cerebrospinal fluid flash back and drug delivery. Increasing the size of the lateral hole has led to mechanical complications, such as tip bending. A new spreading beveled spinal needle tip has been designed to overcome the disadvantages of all the currently used spinal needles. To assess the feasibility, a 26-gauge Quincke spinal needle (B. Braun, Melsungen, Germany) has been modified manually. The new tip-holed design seems to be sound both from theoretical and practical point of view. Searching Medline Plus through their Internet Web site (www.nlm.nih.com) did not reveal the existence of any such spinal needle.

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The PENCAN 25-gauge needle: A new pencil-point needle for spinal anesthesia tested in 1,193 patients

Abstract: A failure rate of 1.9% together with a 1.3% incidence of PDPH were comparable to other 25-gauge pencil-point needles. The rapid appearance of CSF and a perceptible "click" made prompt recognition of successful dural puncture possible.

Cited by 15 publications

References 19 publications

Impact of spinal needle design and approach to postdural puncture headache and spinal anesthesia failure in obstetrics

Impact of spinal needle design and approach to postdural puncture headache and spinal anesthesia failure in obstetrics

Procedural Complications of Spinal Anaesthesia in the Obese Patient

Tip-holed spinal needle: A new design concept

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