title: Influence of needle diameter on spinal anaesthesia puncture failures for caesarean section: A prospective, randomised, experimental study.
abstract: OBJECTIVE
  Spinal anaesthesia represents the technique of choice for elective caesarean section. The purpose of this study was to compare the puncture failure rates with 25, 26 or 27 gauge (G) pencil-point, Whitacre type (with introducer) needles during spinal anaesthesia for caesarean section.
  
  
  METHODS
  Prospective, randomised, experimental study in healthy subjects.
  
  
  METHODS
  We recruited 330 adults, consecutively scheduled parturients, randomised into three groups. The subarachnoid puncture procedure was standardised. The flexibility of the three needle types was assessed in vitro, and a force was applied using a dynamometer. The occurrence of postdural puncture headache was also evaluated.
  
  
  RESULTS
  The number of spinal puncture failures was significantly higher in the 27G group, than in the 25G (P=0.006) group and the 26G (P<0.001) group, but did not differ between the 25G and 26G groups (P=0.606). Ten postdural puncture headaches were observed without significant differences among the groups.
  
  
  CONCLUSIONS
  This prospective study showed that puncture failures occur less frequently with the use of 25G or 26G pencil-point needles as compared to 27G needles, probably due to the higher flexibility of the latter. This characteristic was demonstrated in vitro, in a reproducible model. This experiment suggests that a 26G pencil-point needle is the optimal gauge for performing spinal anaesthesia for scheduled caesarean sections.
authors.affiliation: University Hospital of Messina, Department of Human Pathology, Via Consolare Valeria, 1, 98125 Messina, Italy. Electronic address: famafausto@yahoo.it.
authors.forename: Fausto
authors.initials: F
authors.lastname: Fama'
authors.affiliation: University Hospital of Messina, Department of Human Pathology, Via Consolare Valeria, 1, 98125 Messina, Italy.
authors.forename: Cecile
authors.initials: C
authors.lastname: Linard
authors.affiliation: University Hospital of Tours, Department of Anaesthesiology and Intensive Care, Hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex 9, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Bierlaire
authors.affiliation: University Hospital of Messina, Department of Human Pathology, Via Consolare Valeria, 1, 98125 Messina, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Gioffre'-Florio
authors.affiliation: University Hospital of Tours, Department of Anaesthesiology and Intensive Care, Hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex 9, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Fusciardi
authors.affiliation: University Hospital of Tours, Department of Anaesthesiology and Intensive Care, Hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex 9, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Laffon
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000295:instrumentation*; D000775:Anesthesia, Spinal / Q000295:instrumentation*; D002585:Cesarean Section / Q000295:instrumentation*; D005260:Female; D006801:Humans; D009339:Needles; D051299:Post-Dural Puncture Headache / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D013346:Subarachnoid Space; D017211:Treatment Failure
keywords: Caesarean section; Diameter; Failure; Needle; Postdural puncture headache; Spinal anaesthesia