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Sobot Novakovic S, Rakanovic D, Milic-Radic T. Spinal Introducer Needle Breakage During Spinal Anesthesia for Cesarean Section: A Case Report. Cureus 2023; 15:e46972. [PMID: 38021597 PMCID: PMC10640857 DOI: 10.7759/cureus.46972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Spinal and epidural anesthesia are the preferred choices for patients undergoing a cesarean section (CS). The increased use of neuraxial anesthesia in obstetrics may lead to certain complications such as needle breakage. While several cases of broken spinal and epidural needles have been reported, the exact incidence of needle breakage remains uncertain. The use of pencil-point needles with smaller diameters and the increasing BMI among pregnant individuals may have contributed to the increase in the reported incidents of broken needles during obstetric surgery. We present a case of a patient who was found to have a leftover spinal introducer needle in her back after undergoing spinal anesthesia for CS.
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Affiliation(s)
- Suzana Sobot Novakovic
- Anesthesiology and Critical Care, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Dragan Rakanovic
- Anesthesiology and Critical Care, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
| | - Tanja Milic-Radic
- Obstetrics and Gynaecology, University Clinical Centre of the Republic of Srpska, Banja Luka, BIH
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Alsharif TH, Gronfula AG, Turkistani S, Alshmlany AM, Sharourou Z, Aboueleneein H, Alhamied F. A Systemic Review of Spinal Needles Broken During Neuraxial Anesthesia. Cureus 2023; 15:e40241. [PMID: 37440808 PMCID: PMC10334221 DOI: 10.7759/cureus.40241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 07/15/2023] Open
Abstract
Needle breakage during spinal anesthesia occurs infrequently and represents a serious complication with potentially adverse effects. The objective of this systemic review was to look at the incidence, risk factors, and preventative measures for broken spinal needles. A search of the literature on PubMed, Web of Science, and Embase databases and a manual web search was performed, with no filters and up to April 2023 from inception. Out of the 43 potential studies, 23 were included. The search terms for the full article reading were broken needle, spinal anesthesia, humans, and post-operative, and the exclusion criteria were systematic reviews, conference presentations, and non-full articles. A review of the 23 studies (24 cases) suggests an association between specific risk factors such as obesity and needle size and breaks. Identifying the risks and complications of needle breaks could help physicians modify their practice and inform their patients of any increased risks applicable to them.
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Affiliation(s)
| | - Amin G Gronfula
- Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | | | | | | | - Fawaz Alhamied
- Neurology, King Fahad Armed Forces Hospital, Jeddah, SAU
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3
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Kaboré RAF, Traore IA, Traore SIS, Bougouma CTHWP, Augustin P, Ouro-Bang'na Maman AF. Broken needle during spinal anesthesia: an avoidable complication. Local Reg Anesth 2018; 11:111-113. [PMID: 30538540 PMCID: PMC6260186 DOI: 10.2147/lra.s175547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The occurrence of a needle breaking is a very rare complication of spinal anesthesia (SA). We report a case of a broken spinal needle occurring in a morbid obese pregnant woman during SA indicated for an emergent cesarean section. Multiple puncture attempts due to difficult identification of lumbar spine, associated with an inadequate use of the introducer, contributed to this complication. The recognition of predictive factors for difficult neuraxial anesthesia, the use of ultrasound in obese patients, and a properly executed technique may have allowed avoiding this complication.
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Affiliation(s)
| | - Ibrahim Alain Traore
- Department of Anesthesia, Uiversity Hospital Sourou Sanou, Bobo Dioulasso, Burkina Faso
| | | | | | - Pascal Augustin
- Department of Anesthesia, Intercommunity Hospital of Meulan, Les Mureaux, Meulan en Yvelines, France
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4
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In situ abgebrochene 27-Gauge-Spinalnadel bei einer Re-Resectio. Anaesthesist 2017; 66:115-121. [DOI: 10.1007/s00101-017-0266-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/18/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
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Martinello C, Rubio R, Hurwitz E, Simon M, Vadhera RB. Broken spinal needle: case report and review of the literature. J Clin Anesth 2014; 26:321-4. [DOI: 10.1016/j.jclinane.2014.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 01/11/2014] [Accepted: 01/19/2014] [Indexed: 10/25/2022]
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Lonnée H, Fasting S. Removal of a fractured spinal needle fragment six months after caesarean section. Int J Obstet Anesth 2014; 23:95-6. [DOI: 10.1016/j.ijoa.2013.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/05/2013] [Accepted: 08/08/2013] [Indexed: 11/29/2022]
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You JW, Cho YH. Foraminal stenosis complicating retained broken epidural needle tip -A case report-. Korean J Anesthesiol 2010; 59 Suppl:S69-72. [PMID: 21286465 PMCID: PMC3030061 DOI: 10.4097/kjae.2010.59.s.s69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 05/26/2010] [Accepted: 06/16/2010] [Indexed: 11/10/2022] Open
Abstract
Lumbar epidural anesthesia is useful in a variety of chronic benign pain syndromes, including lumbar radiculopathy, low back pain syndrome, spinal stenosis, and vertebral compression fractures. Given the increased number of epidural nerve blocks being performed, some have reported unexplained complications of a transient or permanent nature and with varying degrees of severity. However, no case has been reported of a broken epidural needle tip retained in the lumbar facet joint area. This represents the first reported case presentation of foraminal stenosis developing in a patient after a retained epidural needle tip.
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Affiliation(s)
- Ji Wong You
- Department of Anesthesiology and Pain Medicine, Seoul Secred Heart Hospital, Seoul, Korea
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Chanelles O, Touboul C, Boujenah J, Cornelis F, Carbillon L, Poncelet C. [A piece of needle of a cesarean section found 45 years later]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2010; 38:770-772. [PMID: 20884268 DOI: 10.1016/j.gyobfe.2010.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Accepted: 04/05/2010] [Indexed: 05/29/2023]
Abstract
We report the case of a patient who had a caesarian section 45 years ago in whom was discovered a piece of needle during assessment of an endometrial cancer. This piece of needle, close to the small bowel, was found inside a hysterotomy scar but no complication occurred during all this time.
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Affiliation(s)
- O Chanelles
- Service de gynécologie-obstétrique, pôle Femme-et-Enfant, CHU Jean-Verdier, AP-HP, avenue du 14-Juillet, Bondy, France.
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Wendling AL, Wendling MT, Gravenstein D, Euliano TY. Fractured Small Gauge Needle During Attempted Combined Spinal–Epidural Anesthesia for Cesarean Delivery. Anesth Analg 2010; 111:245. [DOI: 10.1213/ane.0b013e3181e256da] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Schmittner MD, Terboven T, Dluzak M, Janke A, Limmer ME, Weiss C, Bussen DG, Burmeister MA, Beck GC. High incidence of post-dural puncture headache in patients with spinal saddle block induced with Quincke needles for anorectal surgery: a randomised clinical trial. Int J Colorectal Dis 2010; 25:775-81. [PMID: 20148254 DOI: 10.1007/s00384-010-0888-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2010] [Indexed: 02/04/2023]
Abstract
PURPOSE Spinal saddle block represents nearly the ideal anaesthesia technique for anorectal surgery. Post-dural puncture headache (PDPH) is a dreaded complication but can be decreased by the use of non-cutting spinal needles to rates less than 1%. Though, cutting Quincke type needles are still widely used for economic reasons, leading to a higher rate of PDPH. We performed this study to demonstrate a reduction of PDPH by the use of very small 29-G compared with commonly used 25-G Quincke type spinal needles. METHODS Two hundred sixteen adult patients (male/female, 19-83 years, ASA status I-III) were randomised 1:1 to groups, in which either a 25-G or a 29-G Quincke type spinal needle was used for a spinal saddle block. The incidence of PDPH was assessed during 1 week after surgery. RESULTS Thirty-nine of 216 patients developed PDPH but there was no difference between the two needle sizes (25-G, n = 18/106 vs. 29-G, n = 21/110, p = 0.6870). Women suffered significantly more from PDPH than men (23/86 vs. 16/130, p = 0.0069). Ambulatory patients had a later onset of PDPH than in-patients (24 h [0.5-72] vs. 2 h [0.2-96], p = 0.0002) and the headache was more severe in these patients (NRS 7 [2-10] vs. NRS 3 [1-8], p = 0.0009). CONCLUSIONS The use of 29-G compared with 25-G Quincke needles led to no reduction of PDPH and is considerably higher compared with data from pencil-point needles. The use of non-cutting or pencil-point spinal needles should become the standard for performing spinal saddle block.
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Affiliation(s)
- Marc D Schmittner
- Department of Anaesthesiology and Surgical Intensive Care Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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Ozgun MT, Batukan C, Basbug M, Atakul T. Management of a broken needle: retained in the first caesarean section, removed during the second abdominal delivery. J OBSTET GYNAECOL 2009; 28:653-5. [PMID: 19003675 DOI: 10.1080/01443610802378355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- M T Ozgun
- Department of Obstetrics and Gynecology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
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12
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Pawa A. Epidural needle hub breakage. Int J Obstet Anesth 2007; 16:386-7; author reply 387. [PMID: 17643290 DOI: 10.1016/j.ijoa.2007.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Chin JH, Jun IG, Kim YK, Kang KN, Hwang GS, Hwang JH. Inadvertent Breakage of the Spinal Needle during the Obturator Nerve Block for the Transurethral Resection of Bladder Tumor - A case report -. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.2.250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ji Hyun Chin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gu Jun
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kug Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gyu Sam Hwang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jai Hyun Hwang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Current World Literature. Curr Opin Anaesthesiol 2006; 19:660-5. [PMID: 17093372 DOI: 10.1097/aco.0b013e3280122f5d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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