MD DA DNB Dip DiabMD DCA Dip software based statistics PhD physiology FICA Some history The first spinal anesthetic was administered accidentally by J Leonard Corning Experimenting with cocaine on spinal nerves of a ID: 1046333
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1. Neuraxial needles Dr. S. Parthasarathy MD, DA, DNB, Dip Diab.MD ,DCA, Dip software based statistics,PhD (physiology) FICA
2. Some history The first spinal anesthetic was administeredaccidentally by J. Leonard CorningExperimenting with cocaine on spinal nerves of a dog, accidentally breached dura between two lumbar vertebra, causing paralysis of the hind limbs -inadvertently performed the first spinal anesthesia
3. Corning It was made of a flexible material, with an introducer and a limiter to keep the equipment fixed whilst approaching to the subarachnoid space. The tip of the needle consisted of a short and sharp bevel, based on the hypodermic needle by Alexander Wood
4. Quincke needle Sharp bevel Let down CSF in increased ICT
5. The Bier spinal needle15G or 17G, long, cutting bevelsharp point.No introducer
6. Bainbridge Needle (1900)Short cutting bevel Small circular hub Stylet
7. Barker Needle (1907)Sharp,medium-length bevela styletmatching bevelHard nickel
8. Quincke babcock needle(1914) William Wayne Babcock described a needle in 1914 that was similar to the original Corning needle but had a smaller caliber (20 gauge). It was made of platinum or gold and also known as Quincke-Babcock needle.
9. Labat (1921)Nickel Short bevel Push instead of cutting concept Later – the concept was used for pencil point
10. Hoyt (1922)set of needles for spinal puncture. The external, which served as an usher, was used to penetrate tissue and ligaments to the vicinity of the dura mater Then a thinner needle was inserted inside to penetrate the duraIntroducer sets – forerunner
11. Greene Blunt needles smaller diameter hole resulted from the use of blunt needles compared to those with sharp edgesHelbert or barnett greene – fight ??
12. Pitkin needle short bevel with an angle of approximately 45 degrees from the longer stem to the shorter.Better feel Creates Dural flap which closes !! Paramedian approach concept
13. William T Lemmoncontinuous spinal anesthesia. malleable alloy of nickel/silver and used with an introducer. It had a short and sharp bevel and a lateral hole to facilitate a free flow of CSF After the puncture, was folded and fixed on the skin surface and connected to a rubber tube through which local anesthetic was administered if needed. Finally, the patient had to be positioned on a surgical table mattress with a hole in which the needle protruding dorsal could be adequately accommodated.
14. Lemon mattress
15. So many Others Sise KirschnerHingsonRovenstineCappe & DeutschBraceLevy Cheng
16. So many !!
17. Stylet or introducer Needle Introducer Stylet – other wise tissue coring and block of needle If introducer , stylet use ??
18. Touhy !! Huber developed a tip for hypodermic needles with long, sharp, and fundamentally curved bevel– to decrease tissue damage for routine injection Touhy used it to thread ureteral catheters to spinal and epidural Direction !! huber
19. Whitacre point described as "resembling a sharpened pencil" and a distal side orifice next to it. This description became popular and called these conical tip needles: “pencil point needles”.Ball pen needles !!
20. Whitacre Flow of CSF and spinal injection ?? Whitacre needle is one of the most currently used for spinal and advocated, by many authors, for use in obstetric patients.
21. Rough metallic edges of pencil point needles
22. Crawford (1951)extremely short and, thereby, little sharp bevel. mainly for thoracic punctures, hanging drop technique. 677 thoracic surgeries. No Huber tip
23. HusteadMore blunt More angulatedInsertion of catheter – yes Shearing – less Dural puncture less
24. WeissShort bevel Two flaps Hanging drop easy
25. Lutz Single dose epidural Blunt tipNo catheter – unpopular
26. Hanoaka Touhy huber Needle through needleBack hole
27. Common !!
28.
29. Double lumen epidural needle CSEA Coomb s
30. Sprotte Modifications to whitacre an elongated tip in an attempt to promote a more gradual separation of the dural fibers,, lateral orifice larger and oval to CSF flowAnaesthetic deposition better BUT ??
31. Sprotte Quincke – local anesthetic spread ??
32. Comparison
33. Atraucan characteristic tip with two rows of sharp bevels. most sharp tip promotes the initial incision in the tissues and in the dura mater, second part of the bevel enlarges the hole. thinnest and relatively fragile tip which may fracture during the puncture.
34. Single bony contact – atraucan needle
35. LEE needle What we use Removable flange
36. Episure Specifically engineered internal compression spring which applies a precise force on the plunger, regardless of the amount of saline drawn into the syringePlunger automatically depresses when the needle enters the Epidural SpacePlunger has extremely low friction coefficient and moves very smoothly
37. Epidural needles are made of ?? Iron 69 % Chromium – 18 % Nickel – 9 % Manganese – 1.5% Silicon + molybdenum – traces
38. Dural hole 22 g needle 29 G needle
39. Pearls Originally thought - pencil point needles cause less dural trauma But no --- They cause more edema more inflammation to seal the hole to cause less PDPH pencil-point needles caused two to three times less fluid loss than the Quincke beveled needles. (1 hour let off)The outer diameter of same 25 G needles may vary – the force for the puncture of the dura different !!
40. Summary Quincke , greene, sprotte , atraucan Crawford Touhy Lee needles Pros and cons
41. Thank you all