Development of the cutting spinal needle tip (1)

In 1891, Quincke published a paper describing a standardized lumbar puncture technique used to release cerebrospinal fluid (CSF) for the treatment of diseases associated with increased intracranial pressure. He used a needle that was hard to find, but it was a sharp, beveled, hollow needle.

The next major development in the history of spinal anesthesia is the work of Augustus Karl Gustav Bier. In 1898, both he and his assistant received cocaine spinal anesthesia. The assistant first injected Bill, and then his assistant Bill. The first operation caused a tingling sensation in Bier's leg, and his assistant tried to connect the syringe to the needle, causing a large amount of cerebrospinal fluid and cocaine solution to leak. The resulting complications are those that are not uncommon today: failed block, nerve contact with the needle, and postdural headache (PDPH). Bill then successfully intercepted his assistant. After these experiments, Bill took a historic step by using spinal anesthesia to provide pain relief for surgery. In 1899, he published six case reports of cocaine spinal anesthesia and lower limb surgery. The needle used is described as a Quincke needle. Bill's work caused a sensation in the medical world, and the surgical technique was widely accepted, although Bill himself still had reservations. Over time, he developed his own needle (Figure 2). He felt that it was troublesome to use introducer and dilator to insert the thin needle previously used, so he designed a large-caliber needle that does not require an introducer. The spinal needle is 15G or 17G, with a long cutting bevel and a pointed tip.

Figure 2

spinal needle（1899）

Soon after the introduction of the Bill Spine Needle, the importance of needle size and bevel shape was recognized. Bier's spinal needle has been criticized for causing pain during insertion, leaving a large hole in the dura mater, and causing loss of epidural local anesthetic because the hole may span the dura mater.

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