title: A directional needle improves effectiveness and reduces complications of microcatheter continuous spinal anaesthesia.
abstract: The present prospective randomized study compares the impact of two different spinal needle designs--non-directional versus directional--on the effectiveness of continuous spinal anaesthesia provided via a microcatheter in orthopaedic patients. Using the midline approach, a 28-gauge spinal catheter was inserted either through a 22-gauge Quincke needle (non-directional, Group 1, n = 21) or a 22-gauge Sprotte needle (directional, Group 2, n = 21) under standardized conditions. The incidence of technical difficulties and postoperative complaints, onset time of analgesia at the level of T10 and dose requirement of plain bupivacaine 0.5% were recorded. Postoperatively, the subarachnoid position of the catheters was radiographically evaluated. There was a higher incidence of technical problems during catheter insertion in Group 1 compared with Group 2 (71% vs 19%, P < 0.05). Onset time of analgesia was shorter (P < 0.05) and anaesthetic dose requirement was lower in patients in Group 2 than in Group 1. While 40% of the catheters were found in a caudal position in Group 1, all catheters were in a cranial position or at the level of the puncture site in Group 2 (P < 0.05). There was no difference in the incidence of postoperative complaints between the groups. The faster onset of analgesia and lower dose requirement of local anaesthetics associated with a lower incidence of technical problems suggest that there is greater effectiveness and safety when microcatheters are inserted using directional needles rather than non-directional needles.
authors.affiliation: Department of Anaesthesiology, University Hospital Eppendorf, Hamburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Standl
authors.forename: S
authors.initials: S
authors.lastname: Eckert
authors.forename: I
authors.initials: I
authors.lastname: Rundshagen
authors.forename: J
authors.initials: J
authors.lastname: Schulte am Esch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000295:instrumentation*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002648:Child; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008845:Microinjections / Q000009:adverse effects / Q000295:instrumentation*; D008875:Middle Aged; D009339:Needles / Q000009:adverse effects; D011183:Postoperative Complications; D011446:Prospective Studies; D011859:Radiography; D012449:Safety; D013129:Spinal Puncture / Q000009:adverse effects / Q000295:instrumentation; D013346:Subarachnoid Space / Q000000981:diagnostic imaging
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine