Summary of spinal dural needle
Dec 04, 2021
The CSE technique is a well-established method for all types of surgery, especially in obstetrics. The CSE technique was the most commonly used regional technique for labor analgesia (97%) and cesarean delivery (54%) in our facilities. The CSE offers many advantages; It provides a means of administering intraspinal anesthesia and analgesia in a variety of clinical Settings.
The CSE technique has the advantages of spinal and epidural techniques and therefore has a high success rate in providing regional anaesthesia. CSE provides the ability to quickly initiate and titrate to the desired sensory level, control the duration of block, and provide postoperative analgesia. Another advantage of CSE is easy access of spinal needle into the subarachnoid space. The Tuohy needle guides the spinal needle almost to the subarachnoid space. This allows the use of smaller sizes of non-invasive spinal needles where PDPH does not exist or is rare.
The disadvantages of CSE are that the combination technique introduces potential side effects such as PDPH, increased risk of catheter insertion into the subarachnoid space and transient paresthesia caused by spinal needles. Although the risk is low, a number of device modifications have been recommended and developed to avoid epidural catheters passing through epidural holes made from spinal needles.
The ideal length of spinal needle protrusion beyond the epidural tip has been reported to be at least 12-13 mm. Longer spinal needles were shown to be associated with a significantly higher incidence of transient paresthesia. Using a shorter needle (<10 mm protrusion) may fail to obtain CSF through the spinal needle and cause the technique's spinal component to fail. CSE failure is also related to the wrong puncture site or axis deviation during the needle insertion process. Multiple attempts and operations increase the risk of infection, hematoma and nerve damage, but it is not clear whether CSE technology increases these risks.
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