Broken spinal needle: case report and review of the literature

Martinello, Caroline; Rubio, Ruby Navarro; Hurwitz, Erin E; Simón, M.; Vadhera, Rakesh

doi:10.1016/j.jclinane.2014.01.008

Cited by 12 publications

(20 citation statements)

References 15 publications

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“…Many anesthesiologists do not respect this rule of mobilizing the introducer for withdrawals and changes of direction of the SA needle. 8 In our case, there were two predicting factors of difficult puncture: emergent CS and morbid obesity. The numerous unsuccessful attempts of dural puncture resulted in a plication of the needle, which was weakened, and then severed by the introducer.…”

Section: Discussionmentioning

confidence: 59%

“…The mobilization of the needle through the non mobilized introducer favors, first, the bending and the deformation of the needle, and then, the breaking of the needle severed by the blunt end of the introducer. 8 , 9 Some cases of needle breaking not related to the introducer have been described. 10 , 11 Some authors propose the use of larger puncture needles taking into account the benefit and risk balance of such needles.…”

Section: Discussionmentioning

confidence: 99%

“…Taking into account benefits and risks of each option, we decided to proceed to another attempt of SA, mainly because of the morbid obesity. 15 Even if it seems appropriate to continue the puncture attempt at another interspinous space level, 8 GA as an alternative should be at least discussed. Considering the risk of definitive neurological damage in case of intradural migration of the fragment, the removal of the needle fragment should be considered as soon as possible.…”

Section: Discussionmentioning

confidence: 99%

“…Considering the risk of definitive neurological damage in case of intradural migration of the fragment, the removal of the needle fragment should be considered as soon as possible. 8 …”

Section: Discussionmentioning

confidence: 99%

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Broken needle during spinal anesthesia: an avoidable complication

Kaboré¹,

Traoré²,

Traoré³

et al. 2018

LRA

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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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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Considering the risk of definitive neurological damage in case of intradural migration of the fragment, the removal of the needle fragment should be considered as soon as possible. 8 …”

Section: Discussionmentioning

confidence: 99%

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Broken needle during spinal anesthesia: an avoidable complication

Kaboré¹,

Traoré²,

Traoré³

et al. 2018

LRA

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“…Complications such as nausea and vomiting have reported incidences as high as 80% in obstetric patients, while PDPHs occur about 1-2% of the time after the administration of spinal anesthesia or inadvertent dural puncture after epidural procedure [ 3 ]. The incidence of broken spinal needles is not well reported [ 4 ]; however, more cases of broken needles in obstetric patients have been noted in the literature over the last decade.…”

Section: Introductionmentioning

confidence: 99%

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

Shah

Vanderhoef

Ibrahim

2020

Case Reports in Anesthesiology

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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.

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In situ abgebrochene 27-Gauge-Spinalnadel bei einer Re-Resectio

et al. 2017

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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.

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Broken spinal needle: case report and review of the literature

Cited by 12 publications

References 15 publications

Broken needle during spinal anesthesia: an avoidable complication

Broken needle during spinal anesthesia: an avoidable complication

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

In situ abgebrochene 27-Gauge-Spinalnadel bei einer Re-Resectio

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