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Atraumatic spinal needles
Author(s) -
Turner M.A.,
Shaw M.
Publication year - 1993
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.1993.tb07050.x
Subject(s) - citation , medicine , woodland , library science , genealogy , history , biology , computer science , botany
It is intriguing that, considering the number of inadvertent dural punctures, how little documentary evidence exists on the problems caused by free cerebrospinal fluid (CSF) in identifying the epidural space during further attempts to insert an epidural catheter. We were, therefore, extremely interested to read the correspondence from Nejad (Anaesthesia 1992; 41: 1007) as we were preparing our own report. A 53-year-old obese woman, with non-insulin dependent diabetes, obstructive and restrictive airway disease was admitted for cholecystectomy. Following induction of general anaesthesia the epidural space was identified at the Ll-, interspace using loss of resistance to air. An inadvertent dural puncture occurred, with free flow of CSF. The needle was withdrawn and the epidural space identified at TI,-L,, using the same technique, and a catheter inserted 4 cm in a cephalad direction. Aspiration produced 0.2 ml of clear fluid. Since there was no technical problem in identifying the epidural space at the second attempt the catheter was secured in place and surgery was allowed to commence. Thirty minutes later 0.3 ml of clear fluid was again aspirated through the catheter, but this time with great difficulty. Laboratory examination of the fluid confirmed it to be CSF. It was decided to give a test dose to confirm the position of the catheter while the patient remained anaesthetised; 1 ml of 0.375% plain bupivacaine was injected. Further aliquots of 1 ml up to a total of 5 ml, produced no cardiovascular changes. At the end of surgery, after reversal of neuromuscular blockade a further 5 ml of 0.375% plain bupivacaine was administered, followed by a continuous infusion of 0.17% plain bupivacaine with diamorphine, which produced excellent analgesia from T, to L,. Two days postoperatively, she developed a severe headache, characteristic of dural puncture, which was treated successfully by patching with autologous blood. We therefore agree with Nejad in the difficulty in distinguishing between CSF from the subarachnoid space, and that which has leaked into the epidural space.