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Broken spinal needle: Case report and review of literature
Abstract Number: T 45
Abstract Type: Case Report/Case Series
Introduction:The occurrence of broken spinal and epidural needles is a rare event. There is little information in literature about management of such cases. We report one case of a retained spinal needle fragment during attempt to perform a spinal anesthesia.
Case report:A 26 y/o term parturient with a BMI of 48.2 presented for elective repeat cesarean section. Spinal anesthesia was the technique chosen. During first attempt at L3-4 interspinous space, a 25G 3.5” Whitacre needle through a 20G introducer was unable to reach the space. It was decided to use a longer spinal needle. To preserve the angulation for the longer needle, the introducer was left in situ and the spinal needle was withdrawn through it. After few cm withdrawal was met with resistance, so both introducer and spinal needles were withdrawn together. Distal 4 cm of the spinal needle was found missing. There were no pain or radicular symptoms. A second attempt at L2-3 interspace with the long needle was successful and satisfactory subarachnoid anesthesia was obtained. During surgery patient developed anaphylaxis, which required resuscitation and epinephrine to maintain hemodynamic stability. After the completion of the case, fluoroscopy showed the needle was not near the spinal canal. Given the patient’s intraoperative complication, the neurosurgery recommendation was to leave the needle fragment in place with a two week follow-up. The patient was informed and was asymptomatic at discharge. She developed symptoms one month after the surgery and the needle fragment was removed surgically without complications.
Review of literature in the following medical search databases:"Pubmed","Medline","Cochrane" and "Up to Date" with the terms: "spinal needle" plus the words "broken","fractured" and "breakage" was conducted. Out of 36 articles found in English language 15 were considered by the authors to be relevant to the case.1-15 Literature review and our experience identified two major risk factors: obesity and withdrawal of a spinal needle through an introducer, and therefore this practice should be avoided. In 81% of cases needle was surgically removed. Our recommendations in the event of a spinal needle fracture in similar scenario are: cancellation of the surgery is unnecessary, spinal block done at another level is a safe option and the spinal needle fragment should be removed as soon as it is safe for the patient to avoid future patient discomfort.
References:Int J Obstet Anesth 2006;15(2):178 Reg Anesth Pain Med 2006;31(2):186 Anesth Analg 1997;85(1):230 Anesthesiology 1977;46(2):147 Reg Anesth 1994;19(4):293 Anesth Analg 1993;77(2):401 Korean J Anesthesiol 2010;59:S69 Int J Obstet Anesth 2007;16(1):94 Rev Bras Anestesiol 2004;54(6):794 Anesth Analg 1992;75(6):1050 Anesth Analg 1996;82(1):217 J Altern Complement Med 2007;13(1):129 Int J Obstet Anesth 2009;18(3):295 Anaesth Intensive Care 1997;25(1):96 Anesth Analg 2010;111(1)245