Broken Spinal needle ( 腰麻针折断)

shenxiu2

30 years old lady . Elective  Caesarean Section for primigravida with  breech presentation.
Planned for spinal anesthesia .
Quinke 27G spinal needle inserted from paramedian approach , at L 23 level , while patient is lying on right lateral position.
During insertion , there was no difficulty , needle advanced until " give " sensation was felt  . Clear CerebroSpinal Fluid  was seen.  While waiting for the CSF flow to reach the hub of the needle , the patient had a sudden jerky movement . The CSF stopped flowing , the anesthesiologist  tried to pull out the needle a little , hoping that the CSF will flow again , but did not see any fluid coming out. So she decided to pull out the needle & reinsert , but when the needle was being pull out , only 3/4 of the length was pulled out.  Apparently the needle had broken inside the patient.

What will you do next?

魏铁钢

英文不是 太好,不过勉强看明白.

主要是制动的问题,我做麻醉的时候一定会跟患者说明白,不要动,而且还找个有个护士在患者前面把着.

说实在的置入腰麻针的时候真怕刺激到神经导致患者掉地下,

shenxiu2

The problem was explained to the patient & her husband. The patient was then put under general anesthesia , caesarean section was done to delivered her baby .

After the caesarean section , she was then referred to the neurosurgeon . Localization of the broken spinal needle was done using the portable X ray machine ( Image Intensifier) , she was then positioned prone , and the neurosurgeon opened up the back ( about 5 cm incision ) where the location of the needle was identified & marked. The needle was retrieved . And the wound closed. The localization took about 20 minutes, and the surgery to remove the needle took another 20 minutes. The needle was outside of the spinal space .
The patient was then reversed & woken up . She was observed for signs of spinal irritation and neurological deficit.  
The recovery was uneventful.

This is the first time I have seen such a case like this .
We had sent the broken  spinal needle to the company that supplied the needle & asked them to make a study as to whether it was due to the defect of the needle that had caused the breaking .
As this is a potential medicolegal case , so all documentations were done carefully in details.

loong

The needle was outside of the spinal space .

jli

Thanks for sharing. A rare but interesting case.

- overseas Anaesthetist

好麻师不好当

Apparently the needle had broken inside the patient.What will you do next?

出自[Case discussions] Broken Spinal needle ( 腰麻针折断)



明显的这个穿刺针已经断在病人体内了，接下来你该怎么办呢？

TIMOR赵

该患者为择期剖腹产：制动，神经科急会诊，局麻下取出剩余1/4针尖，再行剖腹产手术
（急诊剖腹产，先手术，后急诊科会诊，取出剩余1/4针尖）