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• W2093600462 abstract "Spinal anaesthesia has been used for many years with significant changes occurring lately, including the use of finer needles. When local anaesthetic is injected, drops of local anaesthetic may form at the junction between the syringe and the spinal needle. In those subarachnoid blocks when low volumes of local anaesthetic are used, these drops may represent a significant proportion of the intended injected volume. We could find no information about the size of these drops in the literature. In this experiment, we measured the size of these drops during simulated spinal anaesthesia by weighing the amount of fluid lost. To simulate the back of a patient, a joint of beef was placed on a bridge. Under the bridge was a balance (A.L.400D BDH Balance Service Ltd) which measured in increments 0.01 g. A spinal needle was then inserted into the joint of beef. Different sizes of needles were used (18, 20, 22 and 25 gauge) and inserted to a depth of 6 cm. This depth was chosen since the average depth to the epidural space is 5 cm and the subarachnoid space is just beyond [1]. The stylet in the needle was withdrawn and either a 2-ml syringe or a 5-ml syringe was attached. The syringe contained 2 ml of 0.5% hyper baric (8% dextrose monohydrate) bupivacaine. The local anaesthetic was then injected over 10 s and any fluid lost fell on the balance and the weight was noted. The spinal needle was then withdrawn and resited. This procedure was repeated a total of five times with each syringe and with each spinal needle. The figure 1 shows the weight of fluid lost with every size of spinal needle used with each syringe. Statistical analysis was carried out using the two-way anova (Easystat Biosoft Ltd, Cambridge). The amount of fluid increased with the thinner needles above 20 gauge and fluid loss was greater with 5- than with 2-ml syringes (p < 0.05). All of the fluid lost was as a single drop, except when a 25-gauge needle and 5-ml syringe was used, when two drops occurred in some experiments. The density of the 0.5% hyperbaric bupivacaine was calculated by weighing 1 ml of 0.5% bupivacaine. This was repeated five times and the specific gravity found to be 1.07. Finer needles are being used by anaesthetists for spinal anaesthesia to reduce the risk of a lumbar puncture headache [2]. Our results suggest that the amount of fluid lost at the junction between the spinal needle and the syringe is influenced by the gauge of the spinal needle and the size of the syringe. The larger the syringe and the smaller the gauge, the greater the fluid loss. Smaller needles would be expected to accentuate any leakage from the needle/syringe junction because they will increase the resistance to flow. The reason why a 5-ml syringe should have such a pronounced effect is less clear. It may relate to the difficulties caused by the difference in relative sizes of the two parts. In a review by Greene [3], 25 different factors were cited to influence the distribution of local anaesthetic in the subarachnoid space, some significantly, others not, but loss of fluid at the junction between the spinal needle and syringe was not mentioned. The model used for this study was used before to look at the flexibility of spinal needles [4]. Because it is a simulated spinal, the results should be applied to patients with caution since other factors will alter the size of the drop, such as the force used to connect the needle and syringe. However, clinicians should be aware that the use of fine needles, particularly with 5-ml syringes, can result in the loss of significant amounts of anaesthetic drug. If local anaesthetic is seen to be lost it should not be ignored." @default.
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• W2093600462 date "1999-06-01" @default.
• W2093600462 modified "2023-10-16" @default.
• W2093600462 title "Local anaesthetic loss during simulated spinal anaesthesia" @default.
• W2093600462 cites W2110658333 @default.
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• W2093600462 doi "https://doi.org/10.1046/j.1365-2044.1999.96794x.x" @default.
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