title: Hyperbaric dye solution distribution characteristics after pencil-point needle injection in a spinal cord model.
abstract: BACKGROUND
  The flow-rate limiting and directional characteristics of caudally directed microcatheters, which lead to intrathecal maldistribution of hyperbaric 5% lidocaine, are believed to have contributed to at least 11 cases of cauda equina syndrome. The authors investigated the distribution characteristics of hyperbaric dye solutions via caudally directed side port needles at various rates of injection in a spinal cord model to determine the potential for maldistribution.
  
  
  METHODS
  Using a digital video image processing technique, we injected a hyperbaric solution of phthalocyanine blue dye through caudally directed side-port needles into a supinely oriented transparent spinal canal model filled with simulated cerebrospinal fluid. Injections via commonly used spinal needles (24-gauge and 25-gauge Sprotte, and 25-gauge and 27-gauge Whitacre) were recorded using five injection rates (2, 4, 6, 8, and 16 ml/min).
  
  
  RESULTS
  For all needles tested, injection rate had a significant effect on the peak dye concentration (P < 0.0001). Injection rates > or = 6 ml/min (2 ml/20 s) resulted in peak dye concentrations of less than 168 mg/1 (extrapolated concentration of 1% lidocaine). Injection via the 24-gauge Sprotte needle, which has a larger orifice area and internal diameter, resulted in significantly lower peak dye concentrations than via the smaller Whitacre needles tested (P < 0.05).
  
  
  CONCLUSIONS
  Sacral maldistribution could be minimized by using injection rates > or = 6 ml/min (2 ml/20 s), for all of the side-port spinal needles used in this model study. When very slow injection rates (2 ml/min) are used, peak dye concentrations varied inversely and significantly with needle internal diameter and orifice area.
authors.affiliation: Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Holman
authors.forename: R A
authors.initials: RA
authors.lastname: Robinson
authors.forename: D
authors.initials: D
authors.lastname: Beardsley
authors.forename: S F
authors.initials: SF
authors.lastname: Stewart
authors.forename: L
authors.initials: L
authors.lastname: Klein
authors.forename: R A
authors.initials: RA
authors.lastname: Stevens
mesh_terms: D000779:Anesthetics, Local / Q000493:pharmacokinetics*; D004396:Coloring Agents / Q000493:pharmacokinetics*; D007211:Indoles / Q000493:pharmacokinetics*; D007267:Injections; D008012:Lidocaine / Q000009:adverse effects / Q000493:pharmacokinetics; D009339:Needles; D009942:Organometallic Compounds / Q000493:pharmacokinetics*; D013116:Spinal Cord / Q000378:metabolism*
chemical_list: D000779:Anesthetics, Local; D004396:Coloring Agents; D007211:Indoles; D009942:Organometallic Compounds; C015445:copper phthalocyanine; D008012:Lidocaine