title: The Wiley Spinal Catheter-Over-Needle System for Continuous Spinal Anesthesia: A Case Series of 5 Cesarean Deliveries Complicated by Paresthesias and Headaches.
abstract: Intrathecal catheter devices using a catheter-over-needle design and softer flexible material have been introduced to clinical practice with the aim of reducing some of the complications such as postdural puncture headaches and paresthesias seen with previous versions of intrathecal catheters. We present a case series of 5 cesarean deliveries using the Wiley Spinal intrathecal system (Epimed, Johnstown, New York), which was recently approved by the US Food and Drug Administration. The intrathecal catheter system consists of a flexible 23-gauge intrathecal cannula over a 27-gauge pencil-point spinal needle. The placement of the intrathecal catheter was successful in all 5 cases; however, paresthesias in 3 cases and postdural puncture headaches in 2 cases complicated the placement and use of the device. Although the unique catheter-over-needle design facilitates the use of smaller-gauge spinal needles for dural puncture and larger-gauge catheters for medication administration, this case series using the Wiley Spinal suggests that paresthesias and postdural puncture headaches may still limit its widespread utilization. Future studies are needed to determine the true incidence of complications and to determine the role of continuous spinal anesthesia in the obstetric population.
authors.affiliation: From the Stanford University School of Medicine and Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, CA.
authors.forename: Christine P
authors.initials: CP
authors.lastname: McKenzie
authors.forename: Brendan
authors.initials: B
authors.lastname: Carvalho
authors.forename: Edward T
authors.initials: ET
authors.lastname: Riley
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000295:instrumentation*; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000295:instrumentation*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects*; D002408:Catheters, Indwelling; D002585:Cesarean Section; D004867:Equipment Design; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006261:Headache / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D009020:Morphine / Q000008:administration & dosage; D009339:Needles; D010292:Paresthesia / Q000139:chemically induced* / Q000175:diagnosis; D011247:Pregnancy; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D005283:Fentanyl; D002045:Bupivacaine