Broken spinal needle: Clinical case and a brief review of the literature
DOI:
https://doi.org/10.5281/zenodo.10999015Keywords:
Cesarean Section, Obesity, Spinal, AnesthesiaAbstract
Background: Spinal anesthesia can present various complications, one of which is the breakage of a spinal needle within the intrathecal space, which is one of the least frequent complications and it may be serious. A case of spinal needle breakage is presented, pointing out its risk factors and recommendations to reduce it.
Clinical case: 25-year-old female patient, who was scheduled for removal of translocated intrauterine device causing chronic pain. When attempting a spinal anesthesia, stylet was removed from the needle and directed into the subarachnoid space. Upon extraction, the spinal needle was deformed and shortened. Immediately and with fluoroscopy and local anesthesia, the broken fragment was extracted without complications. Regional anesthesia is widely used in pregnant women, as it is considered safe. However, there are factors that increase the probability of a spinal needle breakage (obesity, pregnancy, emergency procedures, incorrect handling of the spinal needle, etc.). Even so, there are various recommendations (use of ultrasound, proper handling of the needle, reducing the number of attempts, etc.) that can reduce the risk of spinal needle breakage.
Conclusion: Risk factors for spinal needle breakage should be identified, in order to decrease its incidence.
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References
Alsharif TH, Alanazi AT, Deif A, et al. Successful Management of a broken spinal needle during difficult spinal anesthesia: A case report. Cureus 2023;15(5): e38822. doi: 10.7759/cureus.38822.
Shah SJ, Vanderhoef K, Ibrahim M. Broken spinal needle in a morbidly obese parturient presenting for urgent cesarean section. Case Rep Anesthesiol 2020;2020:8880464. doi: 10.1155/2020/8880464.
Cruvinel MGC, Andrade AVC. Needle fracture during spinal puncture. Case report. Rev Bras Anestesiol 2004;54:796-8. doi: 10.1590/s0034-70942004000600007.
Alshariff TH, Gronfula AG, Turkistani S, et al. A systemic review of spinal needles broken during neuraxial anesthesia. Cureus 2023;15(6):e40241. doi: 10.7759/cureus.40241.
Campos MG, Peixoto AR, Fonseca S, et al. Assessment of main complications of regional anesthesia recorded in an acute pain unit in a tertiary care university hospital: a retrospective cohort. Braz J Anesthesiol 2022;72(5):605-3. doi: 10.1016/j.bjane.2021.03.011.
Abou-Shameh MA, Lyons G, Roa A, et al. Broken needle complicating spinal anaesthesia. Int J Obstetric Anesth. 2006;15:178-9. doi: 10.1016/j.ijoa.2005.10.014.
Martinello C, Rubio R, Hurwitz E, et al. Broken spinal needle: case report and review of the literature. J Clin Anesth 2014;26:321-4. doi: 10.1016/j.jclinane.2014.01.008.
Kaboré RAF, Traore IA, Traore SIS, et al. Broken needle during spinal anesthesia: an avoidable complication. Local Reg Anesth. 2018;11:111-3. doi: 10.2147/LRA.S175547.
Gentili ME, Nicol JB, Enel D, et al. Recovery of a broken spinal needle. Reg Anesth Pain Med 2006;31:186. doi: 10.1016/j.rapm.2005.11.012.
Utariani A, Arifi AK, Lalita A, et al. Broken needle during spinal anesthesia: How can It happen and how to take it? J Anesth Clin Res 2019;10:3 doi: 10.4172/2155-6148.1000882.
Lonnée H, Fasting S. Removal of a fractured spinal needle fragment six months after caesarean section. Int J Obstet Anesth 2014;23:95-6. doi: 10.1016/j.ijoa.2013.08.006.
Harper JAJ, Lakshman WDH. P.156 Fractured spinal needle: a rare, but potentially dangerous complication of spinal anaesthesia. Int J Obst Anesth 2021;46(Suppl 1):103154.
Thomsen AF, Nilsson CG. Broken small-gauge spinal needle. Anesth Analg 1997;85:230-1. doi: 10.1097/00000539-199707000-00050.
Wendling AL, Wendling MT, Gravenstein D, et al. Fractured small gauge needle during attempted combined spinal-epidural anesthesia for cesarean delivery. Anesth Analg 2010;111:245. doi: 10.1213/ANE.0b013e3181e256da.
Teh J. Breakage of Whitacre 27 gauge needle during performance of spinal anaesthesia for caesarean section. Anaesth Intensive Care 1997;25:96.
Rieg AD, Dortgolz A, Macko S, et al. In situ abgebrochene 27-Gauge-Spinalnadel bei einer Re-Resectio. Fallbericht und Übersicht über die Literatur. Anaesthesist 2017;66:115-21. doi: 10.1007/s00101-017-0266-8.
Greenway MW, Vickers R. Broken micro-tip spinal needle. Int J Obstet Anesth 2009;18(39):295-6. doi: 10.1016/j.ijoa.2009.03.002.
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