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• W2048082608 abstract "We wish to comment on the spinal needle insertion technique advocated by Drs Ahn, Choi and Kim [1]. They reported that when performing combined spinal epidural anaesthesia with the needle-through-needle or double segment techniques the spinal needle was advanced until a dural click was felt, or, ‘if a dural click was not apparent, the needle was advanced until it met notable resistance or there was paraesthesia’. Eliciting paraesthesia during spinal needle insertion indicates that the tip of the needle is adjacent to spinal nerve roots, or, potentially, the spinal cord. A retrospective review by Horlocker and colleagues [2] reported permanent neurological deficits in six of 4767 consecutive spinal anaesthetics (0.13%). They identified paraesthesia during needle placement as a significant risk factor for the development of subsequent persistent neurological deficits. It seems prudent, therefore, to avoid generating paraesthesia, rather than seeking to elicit it. It is well known that anaesthetists, whatever their experience, often fail to correctly identify the vertebral level. In 2000, Broadbent et al. [3] investigated anaesthetists' ability (or more precisely, inability) to identify a marked lumbar space; they showed that vertebral levels were identified correctly only 29% of the time. In the rest, the true level was between one space below and four spaces above the assumed level. It was also noted that in 19% of patients the spinal cord ended below the level of the first lumbar vertebra. We believe that when performing spinal anaesthesia (or combined spinal epidural anaesthesia) the needle should be inserted no further than is absolutely necessary to ensure free flow of CSF. This can often mean that once the needle has passed through the ligamentum flavum the stilette may need to be withdrawn from the hub several times during advancement to check for CSF flow before it enters the dura. We suggest that needle advancement until the occurrence of paraesthesia should not be recommended. Rajakulendran, in a report of spinal cord injury during spinal anaesthesia, states ‘following the golden rule: never inject when the patient experiences pain or paraesthesia even though transient’[4]. These would appear to be wise words from those with firsthand experience. Finally, we would like to point out that the purpose of the study was to compare the frequency of paraesthesia between two combined spinal epidural techniques. Surely, then, it cannot be appropriate for the outcome being investigated to be one of the end-points used for determining correct spinal needle position." @default.
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• W2048082608 date "2006-12-01" @default.
• W2048082608 modified "2023-09-23" @default.
• W2048082608 title "Eliciting paraesthesia during combined spinal epidural anaesthesia" @default.
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• W2048082608 doi "https://doi.org/10.1111/j.1365-2044.2006.04883.x" @default.
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