IN-VITRO INVESTIGATION OF CEREBROSPINAL-FLUID LEAKAGE AFTER DURAL PUNCTURE WITH VARIOUS SPINAL NEEDLES

Postspinal headache is one of the most common complications of spinal anesthesia and has repeatedly led to controversy concerning needle siz e and configuration. In apt in vitro investigation, we measured cerebr ospinal fluid (CSF) leakage with Sprotte, Whitacre, Quincke, and Atrau can needles under physiological conditions in human dura. The puncture characteristics were examined under an electron microscope. The penci l-point needles show 2-3 times less leakage of CSF compared with the c utting Quincke needles of corresponding size. Between the Sprotte and the Whitacre needles, there were no significant differences. The least loss of CSF occurred with the 26-gauge Atraucan needle. Under the ele ctron microscope, a sharply delineated, persistent perforation channel was shown with the Quincke needles, which may explain the high CSF lo ss. With pencil-point needles, which push the tissue apart bluntly, a large opening on the inside is found, with some tearing of the dura. H owever, in contrast to the cutting needles, a persistent perforation c hannel is not manifested. The 26-gauge Atraucan needle, which both cut s and pushes apart conically, shows a relatively discrete opening on t he inside, with slight tears in the dura and arachnoidea but without a visible perforation channel. The results of our study show that large r needles (26-gauge Atraucan) that are easier to handle can lead to go od and, in some cases even better, puncture results if they have chara cteristics of both the cutting and the pencil-point needles, Implicati ons: We compared several brands of pencil-point and standard cutting s pinal needles of varying sizes. All pencil-point needles had less cere brospinal fluid leakage, the least loss occurring with 26-gauge Atrauc an needles. Electron microscopic examination of the dura after punctur e showed characteristic findings with each needle type. We conclude th at the combined cutting and pencil-point characteristics seen in the A traucan needle may have clinical advantages.