Neuraxial needles Dr. S. Parthasarathy MD, DA, DNB, Dip Diab.MD,DCA, Dip software based statistics, PhD (physiology) FICA.

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