title: [In situ broken 27-gauge spinal needle in a repeated caesarean delivery : Case report and literature review].
abstract: We report the rare case of an in situ fracture of a spinal needle within the setting of repeated caesarean delivery in a 28-year-old pregnant woman and discuss the responsible underlying factors. In particular, a wrong technique, limited experience, difficulties to identify the anatomical landmarks, as well as the use of spinal needles smaller than 25 G might promote such a complication. In order to ensure the stability of the spinal needle and to avoid an in situ fracture, the spinal needle should be never moved without the stylet. In case of repeated bone contact, a well-experienced anaesthetist should be consulted, the spinal needle should be replaced and the use of ultrasound is recommended. Next, the use of an atraumatic spinal needle greater than 27 G should be considered to facilitate intrathecal puncture and to avoid the in situ fracture of a spinal needle. Within this context, the risk of post-spinal puncture headache should be balanced. If an in situ fracture of a spinal needle happens, its subsequent removal should be planned without delay by an interdisciplinary team and the anaesthetic method should be chosen with consideration of patient-specific risk factors.
authors.affiliation: Klinik für Anästhesiologie, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland. arieg@ukaachen.de.
authors.forename: A D
authors.initials: AD
authors.lastname: Rieg
authors.affiliation: Klinik für Anästhesiologie, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Dortgolz
authors.affiliation: Klinik für Anästhesiologie, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Macko
authors.affiliation: Klinik für Anästhesiologie, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Rossaint
authors.affiliation: Klinik für Anästhesiologie, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
authors.forename: G
authors.initials: G
authors.lastname: Schälte
mesh_terms: D000328:Adult; D059925:Anatomic Landmarks; D000773:Anesthesia, Obstetrical / Q000295:instrumentation*; D000775:Anesthesia, Spinal / Q000295:instrumentation*; D002585:Cesarean Section / Q000379:methods*; D020878:Device Removal / Q000379:methods; D004868:Equipment Failure; D005260:Female; D006801:Humans; D019300:Medical Errors; D009339:Needles; D011247:Pregnancy; D018084:Ultrasonography, Interventional
keywords: Complications; In situ fracture; Neuroaxial blockade; Spinal needle