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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
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Neuraxial needles
Dr. S. Parthasarathy MD, DA, DNB, Dip Diab.MD ,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 dog, accidentally breached dura between two lumbar vertebra, causing paralysis of the hind limbs -
• inadvertently performed the first spinal anesthesia
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
Quincke needle
• Sharp bevel • Let down CSF in increased ICT
• The Bier spinal needle• 15G or 17G, • long, cutting bevel• sharp point.• No introducer
Bainbridge Needle (1900)
• Short cutting bevel • Small circular hub • Stylet
Barker Needle (1907)
• Sharp,medium-length bevel• a stylet• matching bevel
• Hard nickel
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.
Labat (1921)
• Nickel • Short bevel • Push instead of cutting concept • Later – the concept was used for pencil point
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
Greene
• Blunt needles • smaller diameter hole resulted from the use of
blunt needles compared to those with sharp edges
Helbert or barnett greene –
fight ??
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
William T Lemmon• continuous 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.
Lemon mattress
So many Others • Sise • Kirschner• Hingson• Rovenstine• Cappe & Deutsch• Brace• Levy • Cheng
So many !!
Stylet or introducer
• Needle • Introducer • Stylet – other wise tissue coring and block of
needle
• If introducer , stylet use ??
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
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 !!
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.
Rough metallic edges of pencil point needles
Crawford (1951)
• extremely short and, thereby, little sharp bevel. • mainly for thoracic punctures, • hanging drop technique. • 677 thoracic surgeries.
No Huber tip
Hustead• More blunt • More angulated• Insertion of catheter – yes • Shearing – less • Dural puncture less •
Weiss
• Short bevel • Two flaps • Hanging drop easy
Lutz
• Single dose epidural • Blunt tip• No catheter – unpopular
Hanoaka
• Touhy huber • Needle through needle• Back hole
Common !!
Double lumen epidural needle
• CSEA • Coomb s
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 flow• Anaesthetic deposition better
• BUT ??
Sprotte
Quincke – local
anesthetic spread ??
Comparison
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.
Single bony contact – atraucan needle
LEE needle
What we use Removable flange
Episure
• Specifically engineered internal compression spring which applies a precise force on the plunger, regardless of the amount of saline drawn into the syringe
• Plunger automatically depresses when the needle enters the Epidural Space
• Plunger has extremely low friction coefficient and moves very smoothly
Epidural needles are made of ?? • Iron 69 % • Chromium – 18 % • Nickel – 9 % • Manganese – 1.5% • Silicon + molybdenum – traces
Dural hole
• 22 g needle 29 G needle
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 !!
Summary
• Quincke , greene, sprotte , atraucan • Crawford • Touhy • Lee needles
• Pros and cons
Thank you all