Comparing tissue coring potentials of hollow needles without stylet and caudal needles with stylet

Güldoğuş, Fuat; Barış, Yakup Sancar; Barış, Sibel; Karakaya, Deniz; Kelsaka, Ebru

doi:10.1017/s0265021508003906

Cited by 21 publications

(9 citation statements)

References 8 publications

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“…It has been hypothesised that hollow needles might increase the risk of epidermoid tumours after lumbar puncture because of tissue coring into the spinal space. 35,36 Yet the incidence of acquired epidermoid tumours is so low that sporadic case reports are the only source of available data. 37e40 A 2008 study suggests that cell transportation by caudal needles of any type is confined to non-nucleated epithelial cells.…”

Section: Spreading Of Epidermoid Tissue?mentioning

confidence: 99%

“…37e40 A 2008 study suggests that cell transportation by caudal needles of any type is confined to non-nucleated epithelial cells. 36 Add to this the lower risk of accidental spinal puncture in caudal than in thoracic epidural procedures, and the risk of epidermoid tumours developing in the wake of caudal anaesthesia should be infinitesimal. In any event, as most centres have a policy of applying transdermal local anaesthetics before blocks, prepuncture with a hypodermic needle might be an adequately benign and humane strategy of avoiding the spread of epidermal tissue.…”

Section: Spreading Of Epidermoid Tissue?mentioning

confidence: 99%

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Caudal epidural blocks in paediatric patients: a review and practical considerations

Wiegele

Marhofer

Lönnqvist

2019

British Journal of Anaesthesia

130

125

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Caudal epidural blockade in children is one of the most widely administered techniques of regional anaesthesia. Recent clinical studies have answered major pharmacodynamic and pharmacokinetic questions, thus providing the scientific background for safe and effective blocks in daily clinical practice and demonstrating that patient selection can be expanded to range from extreme preterm births up to 50 kg of body weight. This narrative review discusses the main findings in the current literature with regard to patient selection (sub-umbilical vs mid-abdominal indications, contraindications, low-risk patients with spinal anomalies); anatomical considerations (access problems, age and body positioning, palpation for needle insertion); technical considerations (verification of needle position by ultrasound vs landmarks vs 'whoosh' or 'swoosh' testing); training and equipment requirements (learning curve, needle types, risk of tissue spreading); complications and safety (paediatric regional anaesthesia, caudal blocks); local anaesthetics (bupivacaine vs ropivacaine, risk of toxicity in children, management of toxic events); adjuvant drugs (clonidine, dexmedetomidine, opioids, ketamine); volume dosing (dermatomal reach, cranial rebound); caudally accessed lumbar or thoracic anaesthesia (contamination risk, verifying catheter placement); and postoperative pain. Caudal blocks are an efficient way to offer perioperative analgesia for painful sub-umbilical interventions. Performed on sedated children, they enable not only early ambulation, but also periprocedural haemodynamic stability and spontaneous breathing in patient groups at maximum risk of a difficult airway. These are important advantages over general anaesthesia, notably in preterm babies and in children with cardiopulmonary co-morbidities. Compared with other techniques of regional anaesthesia, a case for caudal blocks can still be made.

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Section: Spreading Of Epidermoid Tissue?mentioning

confidence: 99%

Section: Spreading Of Epidermoid Tissue?mentioning

confidence: 99%

Caudal epidural blocks in paediatric patients: a review and practical considerations

Wiegele

Marhofer

Lönnqvist

2019

British Journal of Anaesthesia

130

125

View full text Add to dashboard Cite

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“…This could be due to many factors, including a different event rate using live human tissue, low quantity of bacteria on tissue cut‐outs, variations in arthroscopic technique relating to needle use, the role of host immunity, or tissue cut‐outs being washed out of the joint during the process of arthroscopy. Previous research has shown that using a needle with a removable trochar or stylet does not decrease the incidence of tissue cut‐out . There are many factors remaining to be explored, but this study highlights the potential for needle insertion technique to play a role in the introduction of foreign material into a joint.…”

Section: Discussionmentioning

confidence: 83%

Epithelial tissue cut‐out following needle insertion into a joint: a potential complication during arthroscopy

Epstein

McCullough

2019

ANZ Journal of Surgery

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Background: Knee arthroscopy is a common orthopaedic procedure and often involves insertion of a needle through skin into a joint. This needle insertion can create epithelial tissue cut-outs possibly containing commensal bacteria that can be flushed into the joint, and potentially lead to post-arthroscopy septic arthritis. This study aims to assess the frequency of epithelial tissue cut-out creation on insertion of different needle sizes at different angles to the skin. Methods: Using an ex-vivo porcine limb tissue model, needles of various gauge (14-23G) were inserted at angles of 90, 60, 45 and 30 to the skin surface. Ten passes were undertaken at each angle. Needle lumen contents were then examined for solid tissue cut-out. Results: Two hundred and eighty needle passes were performed resulting in 70 tissue cutouts (25%) containing solid material. This was more common amongst lower gauge needles. 8 of the 70 (11.4%) tissue cut-outs contained macroscopic evidence of epithelium. The overall rate of epithelial tissue cut-out was 2.9%. The 23G needle had the lowest rate of tissue cut-out creation, occurring twice out of 40 passes (P = 0.002). Neither of these contained macroscopic epithelial tissue. Conclusion: Hypodermic needle insertion through skin into a joint can create epithelial tissue cut-out. Epithelial tissue cut-out occurs more frequently with use of lower gauge needles. This study suggests use of a 23G needle during arthroscopy, inserted either at 60 or 90 to the skin, to reduce epithelial tissue cut-out and any potential contribution to postarthroscopy septic arthritis.

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“…To prevent this epidermal-dermal cell transportation, researchers suggest that all blocks be performed by needles with stylets 2728. Thus, we used needles with stylets for all our caudal blocks.…”

Section: Discussionmentioning

confidence: 99%

Caudal epidural block in children and infants: retrospective analysis of 2088 cases

Beyaz

Tokgöz

Tüfek

2011

Annals of Saudi Medicine

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BACKGROUND AND OBJECTIVES:Regional anesthesia is usually preferred as caudal block via the epidural space. However, the number of large-scale studies including pediatric caudal blocks is small. The objective of this study was to evaluate complications and side effects of local anesthetics and adjuvant drugs.DESIGN AND SETTING:Retrospective, descriptive study of cases occurring during the period December 2007 to October 2009.METHODS:Of 4815 medical records were screened, 2088 pediatric cases were identified and included in this study.RESULTS:As a local anesthetic, we preferred mostly levobupivacaine in 1669 (79.9%) patients and bupivacaine in 419 (20.1%) patients. As adjuvant drug, we preferred mostly morphine (41 patients), fentanyl (7 patients) and adrenaline (6 patients) in 54 (2.5%) patients. For general anesthesia induction, we preferred mostly propofol (1996 patients, 94.2%); for maintenance, sevoflurane (1773 patients, 84.9%). For airway control, we preferred mostly the ProSeal laryngeal mask (PLMA), in 1008 (48.2%) patients. One thousand six hundred five (76.9%) patients were from outpatient clinics and 483 (23.1%) patients were from inpatient clinics. No permanent complication was encountered after caudal blocks.CONCLUSION:We conclude that caudal epidural blocks are a safe and effective method for subumbilical day-case pediatric surgeries when performed by anesthetists.

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Comparing tissue coring potentials of hollow needles without stylet and caudal needles with stylet

Cited by 21 publications

References 8 publications

Caudal epidural blocks in paediatric patients: a review and practical considerations

Caudal epidural blocks in paediatric patients: a review and practical considerations

Epithelial tissue cut‐out following needle insertion into a joint: a potential complication during arthroscopy

Caudal epidural block in children and infants: retrospective analysis of 2088 cases

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