Novel pulsatile cerebrospinal fluid model to assess pressure manometry and fluid sampling through spinal needles of different gauge: support for the use of a 22 G spinal needle with a tapered 27 G pencil-point tip

作者：Ginosar Y^*; Smith Y; Ben Hur T; Lovett J M; Clements T; Ginosar Y D; Davidson E M

来源：British Journal of Anaesthesia, 2012, 108(2): 308-315.

DOI：10.1093/bja/aer372

• cerebrospinal fluid
• lumbar puncture
• post-dural puncture headache

Background. Parallel-walled spinal needles <= 22 G are routinely used for lumbar puncture, despite a reported >= 32% incidence of post-dural puncture headache. A tapered spinal needle (22 G shaft, 27 G tip) is in use in our institution. We hypothesized that despite the smaller dural puncture hole, this needle has similar cerebrospinal fluid (CSF) pressure equilibration times and CSF sampling times to a standard 22 G needle and assessed a range of spinal needles using an experimental pulsatile CSF reservoir.
Methods. The pulsatile CSF reservoir had an oscillating pressure varying between 25 and 15 cm H2O at a cycle frequency of 80 s(-1). We tested seven parallel-walled spinal needles (18-27 G) and the tapered 22/27 G needle. CSF pressure was measured every 2 s by manometry. The time to collect 1 ml CSF samples was measured. Saline 0.9% and mannitol 20% were tested separately. One-way ANOVA with Bonferroni post-hoc test was used to compare 22G, 27G and 22/27G needles.
Results. The mean [standard deviation (SD)] CSF pressure equilibration time (saline) was 40.7 (6.4), 108.7 (6.1), and 51.3 (4.6) s for the 22, 27, and 22/27 G needles (P < 0.0001 for comparisons between 27 G and other needles). The mean (SD) CSF sampling time (saline) was 40.3 (3.1), 225.3 (10.0), and 63.0 (5.2) s for the 22, 27, and 22/27 G needles (P < 0.0001 for comparisons between 27 G and other needles, and P = 0.019 between 22 and 22/27 G needles). Saline was different from mannitol for both measurements and all needles (P < 0.0001).
Conclusions. A 22/27 G tapered spinal needle has similar flow properties to the 22 G needle, despite a 27 G tip.

• 出版日期2012-2