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Japanese Journal of Clinical MonitoringApril 1999
Regional Anesthesia and Pain Medicine
Vol.25 No.2 March-April Supplement 2000
Anesthesia&Analgesia
Supplement, Feburary 2003
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Japanese Journal of Clinical Monitoring April 1999
Comparative study on puncture resistance of spinal anesthesia needles
OH. Yamazaki, A. Hukuyama, Y. Kinefuchi, T. Suzuki and M. Takiguchi
Dept. of Anesthesiology, Tokai Univ. School of Medicine
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It has been demonstrated that spinal anesthesia headache is induced less frequently with needles of smaller diameter and also with Pencil Point needle than with Quincke needle. Consequently, we have performed a comparative study of spinal anesthesia needles by determining their puncture resistance and puncture hole.
[Methods] Study materials included 25G Quincke needle and 25G Pencil Point needle of each side-port type and open-end type. After connected to a push-pull gauge(9500,AIKOH), each spinal anesthesia needle was operated so as to puncture a 0.08-mm thick polyethylene membrane in a rectangular direction at a constant speed using a driving device (MODEL 1307, AIKOH) under recording on a chart recorder (RJG-4124, Nihon Koden) and an oscilloscope (TDS420A, Tektronix). Changes of the puncture resistance and shapes of the puncture hole were observed for comparison.
In a study in which human skin was actually used, after connecting each needle to a load cell (PSM-2K, pressure sensor area ・.5mm, Kyowa Dengyo), the resistance against puncture was recorded as an output on a computer via an amplifier (PCD-100A, Kyowa Dengyo).
[Results] With Quincke needle, the resistance recorded was 30g and its change was small. With Pencil Point needle of side-port type, change of the resistance followed 2-peak curve with a peak puncture resistance of 105g. On the other hand, with Pencil Point needle of open-end type, the puncture resistance increased monotonically up to its peak of 70g. The resistance recorded after complete penetration through the membrane was as low as approx. 6g with Quincke needle, whereas it was maintained as relatively high as more or less 20g with Pencil Point needle of each side-port type and open-end type. With regard to a shape of the puncture hole, it was of ellipse of relatively larger size with Quincke needle, whereas it was of circle of relatively smaller size with Pencil Point needle of both types.
[Discussion] The resistance recorded with Quincke needle was found to be low during puncture as well as after completion of membrane penetration due to particular K3- lancet grinding of its tip which serves for Quincke needle to go through the membrane by incising it during puncture. On the other hand, with Pencil Point needle (including both side-port type and open-end type), the resistance recorded during puncture was found to be high and the puncture hole observed was found to be small due to its particular mode of puncture in which the needle tip goes through the membrane by expanding it under pressure-load. These findings are considered to explain well the advantages of Pencil Point needle in clinical settings that changes of the resistance taking place at the time when the needle has penetrated the ligament or dura can easily be recognized and the incidence of headache is low. The finding obtained with Pencil Point needle of open-end type is considered to support the fact that back flow of the cerebrospinal fluid into it takes place at the time when it has penetrated through the dura, whereas the finding obtained with the one of side-port type is considered to suggest the necessity of advancing it further even after its penetration through the dura because only reduction of the resistance associated with no recognizable back flow of the cerebrospinal fluid may possibly take place at the time when it has penetrated the dura.
[Conclusion] The puncture resistance and shapes of the puncture hole of various types of spinal anesthesia needles were studied in a comparative manner.
(Note)
Pencil Point needle of open-end type: FACIL POINT
Pencil Point needle of side-port type: PENCIL POINT
Quincke needle: K-3 POINT |
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Regional Anesthesia and Pain Medicine
Vol.25 No.2 March-April Supplement 2000
The Open-end 25-Gauge Needle: A New Pencil-Point Needle for Spinal Anesthesia
Kazuko Yokoyama, M..D.
Department of Anesthesiology, Tama-Nagayama Hospital, Nippon Medical School, Tokyo, Japan 206-0025
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[Introduction] The open-end 25-gauge spinal needle is a new pencil-point needle with unique and safety designed needle tip (Fig-1), which makes it possible to perform insertion avoiding tissue cutting, minimize CSF loss and reduce the incidence of post dural puncture headache (PDPH)(1,2), also uniform distribution of local anesthetics is expected. The aim of this study was to document the efficacy and safety of this new open-end pencil point spinal needle and to compare the distribution of anesthetic with Quincke needle.
[Methods] After informed consent, forty ASA PS 1-2 orthopedic patients scheduled for elective surgery of the lower limb surgery under spinal anesthesia were studied. Patients were randomly allocated to one of two groups by spinal needles; (1) a new 25 gauge (G) open-end pencil point spinal needle (n=20, Doctor-Japan Co., Japan) and (2) a 25 G Quincke needle, bevel was directed to nondependent side in lateral position (n=20 TOP Co., Japan). After arrival in the operating room, a standard IV infusion and standard monitoring was started. Dural puncture was performed at L3-4 interspace using the midline approach. After free flow of cerebrospinal fluid had been observed, open-end pencil point needle was fixed there, and Quincke needle bevel was turned toward the nondepending side. 4.0ml of 0.5% plain bupivacaine was injected over 20 seconds. Patient was placed in supine position, then the evolution of sensory block by pinprick method and motor blocks by using a modified Bromage scale were assessed and heart rate and blood pressure were also recorded every 5 minutes for 30 minutes. Recovery of motor blocks and any complications including PDPH were assessed by blinded observer after surgery. Data were expressed as mean ±SD and statistical analysis used Fisher's Exact test: a two sided P value of <0.05 was considered statistically significant.
[Results] Demographic data and patients characteristics were not different between the two groups. Spinal anesthesia was successful in all cases. Both groups did not differ significantly in maximal sensory block height, and to reach and duration of motor block. During 30 minutes period, no serious hemodynamic change was observed in any case. No complication including PDPH occurred in both groups.
[Discussion] The present investigation showed that a new open-end pencil point spinal needle showed good distribution of spinal anesthesia and no complication observed in 7 days post operative period. There is no disadvantage to compare with Quincke needle. Open-end pencil point has following advantages; (1) the shape of this needle tip is less liable to bent due to no side hole, (2) equal distribution of local anesthetic is provided in both side, (3) no chance to bring tissue into the subarachinoid space.
References.
1. Casati A.,et al: AnesthAnalg 87:355-359,1998
2.M.,et al: Anaesthesia 52: 998-1014,1997 |
Fig.1: Needle Tip |
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Anesthesia & Analgesia Supplement February 2003
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Axillary block with newly developed pentagon pointed needle
K. Sekikawa, T. Sekikawa, K. Aizawa, K. Sengoku, O. Takahata,
H.Iwasaki
Asahikawa Medical Collage, Asahikawa, Japan
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Introduction: The Axillary Block is a common anesthestic procedure for patients undergoing operations on an upper extremity. Because the Quncke pointed needle is so sharp, the anesthesiologist cannot easily sense the point of penetration through the axillary sheath. Therefore, obtaining the appropriate field of analgesia can be difficult.
The present study was designed to investigate how sensitively the anesthesiologist could feel the axillary sheath with the new Pentagon pointed needle (Dr.Japan Co,Tokyo,Japan)compared with the Quincke pointed. We also measured the penetration resistance of the axillary sheath using these two kinds of needles in human cadaver.
Materials and methods: STUDY1. Seven patients aged 45 to 79 undergoing the elective orthopedic operations were informed consented about our study described below. All of them were premedicated. The induction of anesthesia was carried out with the propofol and they were insulted the laryngeal mask or intubated the tracheal tube. Subsequently, the anesthesiologist performed the axillary block. In the first instance, we penetrated the axillary sheath with the Quincke pointed needle, measured the sensation of resistance of the sheath using the four-grade scale(1.exellent,2.good,3.fair,4.none)then, in the second instance, with the Pentagon pointed. After that we completed the injection of local anesthetic using the Pentagon pointed needle. Data were evaluated by ANOVA, followed by Mann-Whitney's U test. P<0.05 was considered as statistically significant.
STUDY2. Using the axillary sheath from the cadaver, we measured the maximum resistance(mmHg) to complete the penetration, 5 times with each needle type. Data were evaluated by Student's t-test. P<0.05 was considered as statistically significant.
Result: STUDY1. Axillery block was successful in all 7 patients without any neurological complications. Comparison between two needles: the anesthesiologist could feel the axillary sheath with the Pentagon pointed needle much better than with the Quincke pointed.(Table 1)(P<0.001).
STUDY2. The maximum resistance was significantly higher in the Pentagon pointed needle(45.41±16.38, n=5) than in the Quincke pointed (2.17±0.75, n=5)(P<0.005).
Conclusion: These results suggest that using the Pentagon pointed needle will allow the anesthesiologist to sense more precisely the exact penetration of the axillary sheath when performing the axillary block. We conclude that this newly developed Pentagon pointed needle is particulary useful and increases safty for the axillary block.
| needle type |
exellent |
good |
fair |
none |
| Pentagon pointed (n=7) |
6 |
1 |
0 |
0 |
| Quincke pointed(n=7) |
0 |
0 |
2 |
5 |
table 1:Comparison Between Two Needles with the Sensation of axillary sheath
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Dr. Japan Co.,Ltd.
1-8-5 Shinjuku, Shinjuku-ku,
Tokyo 160-0022, Japan
Phone: (813) 3226-4731Fax: (813) 3226-4773
E-mail: info@drjapan-jp.com
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