Broken needle during spinal anesthesia: an avoidable complication

Spinal Introducer Needle Breakage During Spinal Anesthesia for Cesarean Section: A Case Report

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.

A Systemic Review of Spinal Needles Broken During Neuraxial Anesthesia

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.

Alternative Technique for Difficult Epidural Needle Placement: A Case Report

A central neuraxial block may be difficult to perform in elderly patients with lumbar spine deformities, calcified ligaments, and narrowing of the epidural space. We report a case of difficult epidural needle placement in an elderly patient scheduled for bilateral total knee replacement (TKR). We attempted epidural needle placement many times without success. However, when a modified technique was used, the epidural space was identified easily and confirmed, the epidural catheter was inserted and fixed, and the postoperative epidural analgesia was effective.

Broken Spinal Needle in a Morbidly Obese Parturient Presenting for Urgent Cesarean Section

Neuraxial anesthesia has become the preferred method of anesthesia for nonemergent cesarean delivery and cases where regional anesthesia is not contraindicated. Multiple cases of broken spinal and epidural needles have been reported in the literature over the last several years; however, the specific incidence of needle breakage is still unknown. Less reliance on general anesthesia and increasing parturient body mass index (BMI) has likely contributed to more reports of broken needles during regional anesthesia for obstetric surgery. We describe a case of a broken spinal needle after attempted spinal anesthetic placement for cesarean delivery in a morbidly obese parturient, subsequent postoperative management, and current treatment recommendations.

Ultrasound-Guided Neuraxial Anesthesia

PURPOSE OF REVIEW

There has been a recent surge of interest in clinical applications of ultrasound, which has revolutionized acute pain management. This review is to summarize the current status of ultrasound utilization in neuraxial anesthesia, the most common type of regional anesthesia.

RECENT FINDINGS

Ultrasound-assisted and ultrasound-guided neuraxial anesthesia has improved clinical accuracy and patient safety through landmark identification including proper vertebral level and midline, as well as via measurements on neuraxial space. Direct needle or catheter visualization during the entire procedure has not yet been achieved consistently. The recent introduction of ultrasound into neural anesthesia has clinical performance benefits and patient safety implications, with documented improvement on overall efficacy with higher first attempt success rate as well as less needle pass. More controlled studies are needed for the overall impact of ultrasonography in neuraxial anesthesia in obstetric and non-obstetric patients.