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

Abstract

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.

Broken Needle Embedded in the Body during Vascular Puncture

“…The incidence of a broken needle or needle breakage is not unknown. Broken needles have been reported during dental procedures [ 2 , 3 ], laparoscopy [ 4 ], surgical operation [ 1 ], percutaneous needle biopsy [ 5 ], endobronchial ultrasound-guided-transbronchial needle aspiration [ 6 ], antegrade suture passer of shoulder [ 7 ], bone biopsy [ 8 ], acupunctures [ 9 ], spinal anesthesia [ 10 , 11 ], and the injection of drugs [ 12 , 13 ]. Seven case reports of broken needles during various procedures were reported in 2021 from a PubMed ® search.…”

“…Risk factors associated with needle breakage of antegrade suture passer are thicker tendon, higher tendinosis, and delaminated tears [ 7 ]. Saurin et al reported that emergency procedures, morbid obesity and multiple puncture attempts, redirection without introducer, poorly differentiated landmarks, and resistance to needle advancement increase the risk of a broken needle during spinal anesthesia [ 11 ]. In our case, the patient was obese and had repeated punctures for ABGAs into the femoral artery, which could be considered as the cause of needle breakage.…”

Integrating ultrasound with the combined spinal-epidural kit as a rescue technique during difficult spinal anaesthesia

“…In fact, a case of a broken 4.5 inch (11.4 cm) 25G spinal needle in an obese parturient was recently reported. 15 Wide-bore spinal needles are easier to manoeuvre, however significantly increase the incidence of postdural puncture headache, creating a conundrum. 16 This issue can be overcome using a CSE kit.…”

Diagnosis and Management of a Retained Local Anesthetic Needle Fragment in a Patient Who Underwent Scheduled Elective Cesarean Delivery: A Case Report

“…This case describes the management of a retained needle fragment at the time of local anesthetic infiltration before neuraxial anesthesia for cesarean delivery. There are published case reports of retained spinal needle fragments in the anesthesia literature, [1][2][3][4] and there are reports of diabetic patients with retained needle fragments from insulin injections. 5,6 Our case reports a patient who had a retained needle fragment in subcutaneous tissue who subsequently underwent spinal anesthesia and then assumed the supine position for a cesarean delivery before removal.…”