title: An in vivo evaluation of four spinal needles used for the combined spinal-epidural technique.
abstract: The purpose of this study was to evaluate four pencil-point spinal needles commonly used for combined spinal-epidural (CSE) anesthesia. Four hundred-seven consecutive parturients undergoing cesarean delivery or labor analgesia received a CSE block with a randomly selected pencil-point spinal needle (Becton-Dickinson [B-D] 27-gauge, 119-mm Whitacre; B-D 27-gauge, 120-mm Durasafe; B-D 25-gauge, 120-mm Durasafe; or International Medical Devices' 26-gauge, 124-mm Gertie Marx). Success in obtaining cerebrospinal fluid (CSF) and the incidence of transient paresthesias and postdural puncture headache (PDPH) were compared by using chi2 testing; P < 0.05 was considered significant. Failure to obtain CSF (3%-5%) was not significantly different among spinal needles. The Gertie Marx 26-gauge needle was associated with significantly more paresthesias (29%) than the Whitacre 27-gauge needle (17%). The combined incidence of paresthesias with the Durasafe 25-gauge and Gertie Marx 26-gauge spinal needles (28%) was greater than the combined incidence of paresthesias with the Durasafe 27-gauge and Whitacre 27-gauge needles (18%). The incidence of PDPH did not differ among the four pencil-point spinal needles. We conclude that longer spinal needles are associated with a significantly more frequent incidence of transient paresthesias without residual effects.
  
  
  CONCLUSIONS
  The use of four pencil-point spinal needles in the combined spinal-epidural technique is associated with an inconsequential incidence of spinal headache, a low incidence of paresthesias that are transient with no long-term effects, and a high degree of success independent of spinal needle length.
authors.affiliation: Department of Anesthesiology, Rush Medical College at Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612-3864, USA.
authors.forename: C H
authors.initials: CH
authors.lastname: Herbstman
authors.forename: J B
authors.initials: JB
authors.lastname: Jaffee
authors.forename: K J
authors.initials: KJ
authors.lastname: Tuman
authors.forename: L M
authors.initials: LM
authors.lastname: Newman
mesh_terms: D000767:Anesthesia, Epidural / Q000295:instrumentation*; D000775:Anesthesia, Spinal / Q000295:instrumentation*; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D009339:Needles; D011247:Pregnancy