A clinical comparison between needle-through-needle and double-segment techniques for combined spinal and epidural anesthesia

A. Casati, A. D'Ambrosio, P. De Negri, G. Fanelli, V. Tagariello, F. Tarantino

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background and Objectives. The goal of the present investigation was to compare the double-segment and the needle-through-needle techniques for combined spinal and epidural anesthesia (CSE) in a prospective, randomized, blinded study. Methods. With Ethical Committee approval and patient's consent, 120 patients were randomized to receive CSE by the needle-through- needle (SST; n = 60) or the double-segment technique (DST; n = 60). A blind observer measured the time required from skin disinfection to readiness for surgery (loss of pinprick sensation up to T10), failure of dural puncture, need for epidural top-up before surgery, patient acceptance, and occurrence of complications. Results. No neurologic complications were observed in either group. Time to readiness for surgery was 22.7 ± 8.2 minutes in the SST group and 29.8 ± 8.31 minutes in the DST one (P <.001). Dural puncture was unsuccessful in three patients in the SST group (5%) and in one patient in the DST group (1.6%) (ns); inadequate spread of spinal anesthesia was observed in five patients in the SST group (8.3%) and in eight patients in the DST group (13.3%) (ns). No difference in the incidence of hypotension, postdural puncture headache, and back pain was observed between the two groups. Acceptance of anesthetic procedure was better in the SST (85%) than in the DST group (66.6%) (P <.05). Conclusions. The needle-through-needle technique for CSE requires less time, has no greater failure rate, and results in greater patient satisfaction than the double-segment technique. The use of a spinal needle with an adjustable locking mechanism and protruding up to 15 mm beyond the Tuohy needle improved successful spinal block in the needle-through-needle technique compared with previous reports.

Original languageEnglish
Pages (from-to)390-394
Number of pages5
JournalRegional Anesthesia and Pain Medicine
Volume23
Issue number4
Publication statusPublished - Jul 1998

Fingerprint

Epidural Anesthesia
Spinal Anesthesia
Needles
Punctures
Post-Dural Puncture Headache
Disinfection
Back Pain
Patient Satisfaction
Hypotension
Nervous System
Anesthetics
Skin

Keywords

  • Epidural anesthesia
  • Regional anesthesia
  • Spinal anesthesia

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Casati, A., D'Ambrosio, A., De Negri, P., Fanelli, G., Tagariello, V., & Tarantino, F. (1998). A clinical comparison between needle-through-needle and double-segment techniques for combined spinal and epidural anesthesia. Regional Anesthesia and Pain Medicine, 23(4), 390-394.

A clinical comparison between needle-through-needle and double-segment techniques for combined spinal and epidural anesthesia. / Casati, A.; D'Ambrosio, A.; De Negri, P.; Fanelli, G.; Tagariello, V.; Tarantino, F.

In: Regional Anesthesia and Pain Medicine, Vol. 23, No. 4, 07.1998, p. 390-394.

Research output: Contribution to journalArticle

Casati, A, D'Ambrosio, A, De Negri, P, Fanelli, G, Tagariello, V & Tarantino, F 1998, 'A clinical comparison between needle-through-needle and double-segment techniques for combined spinal and epidural anesthesia', Regional Anesthesia and Pain Medicine, vol. 23, no. 4, pp. 390-394.
Casati, A. ; D'Ambrosio, A. ; De Negri, P. ; Fanelli, G. ; Tagariello, V. ; Tarantino, F. / A clinical comparison between needle-through-needle and double-segment techniques for combined spinal and epidural anesthesia. In: Regional Anesthesia and Pain Medicine. 1998 ; Vol. 23, No. 4. pp. 390-394.
@article{6a29564e925c4e6abec1520b21a8f95e,
title = "A clinical comparison between needle-through-needle and double-segment techniques for combined spinal and epidural anesthesia",
abstract = "Background and Objectives. The goal of the present investigation was to compare the double-segment and the needle-through-needle techniques for combined spinal and epidural anesthesia (CSE) in a prospective, randomized, blinded study. Methods. With Ethical Committee approval and patient's consent, 120 patients were randomized to receive CSE by the needle-through- needle (SST; n = 60) or the double-segment technique (DST; n = 60). A blind observer measured the time required from skin disinfection to readiness for surgery (loss of pinprick sensation up to T10), failure of dural puncture, need for epidural top-up before surgery, patient acceptance, and occurrence of complications. Results. No neurologic complications were observed in either group. Time to readiness for surgery was 22.7 ± 8.2 minutes in the SST group and 29.8 ± 8.31 minutes in the DST one (P <.001). Dural puncture was unsuccessful in three patients in the SST group (5{\%}) and in one patient in the DST group (1.6{\%}) (ns); inadequate spread of spinal anesthesia was observed in five patients in the SST group (8.3{\%}) and in eight patients in the DST group (13.3{\%}) (ns). No difference in the incidence of hypotension, postdural puncture headache, and back pain was observed between the two groups. Acceptance of anesthetic procedure was better in the SST (85{\%}) than in the DST group (66.6{\%}) (P <.05). Conclusions. The needle-through-needle technique for CSE requires less time, has no greater failure rate, and results in greater patient satisfaction than the double-segment technique. The use of a spinal needle with an adjustable locking mechanism and protruding up to 15 mm beyond the Tuohy needle improved successful spinal block in the needle-through-needle technique compared with previous reports.",
keywords = "Epidural anesthesia, Regional anesthesia, Spinal anesthesia",
author = "A. Casati and A. D'Ambrosio and {De Negri}, P. and G. Fanelli and V. Tagariello and F. Tarantino",
year = "1998",
month = "7",
language = "English",
volume = "23",
pages = "390--394",
journal = "Regional Anesthesia and Pain Medicine",
issn = "1098-7339",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - A clinical comparison between needle-through-needle and double-segment techniques for combined spinal and epidural anesthesia

AU - Casati, A.

AU - D'Ambrosio, A.

AU - De Negri, P.

AU - Fanelli, G.

AU - Tagariello, V.

AU - Tarantino, F.

PY - 1998/7

Y1 - 1998/7

N2 - Background and Objectives. The goal of the present investigation was to compare the double-segment and the needle-through-needle techniques for combined spinal and epidural anesthesia (CSE) in a prospective, randomized, blinded study. Methods. With Ethical Committee approval and patient's consent, 120 patients were randomized to receive CSE by the needle-through- needle (SST; n = 60) or the double-segment technique (DST; n = 60). A blind observer measured the time required from skin disinfection to readiness for surgery (loss of pinprick sensation up to T10), failure of dural puncture, need for epidural top-up before surgery, patient acceptance, and occurrence of complications. Results. No neurologic complications were observed in either group. Time to readiness for surgery was 22.7 ± 8.2 minutes in the SST group and 29.8 ± 8.31 minutes in the DST one (P <.001). Dural puncture was unsuccessful in three patients in the SST group (5%) and in one patient in the DST group (1.6%) (ns); inadequate spread of spinal anesthesia was observed in five patients in the SST group (8.3%) and in eight patients in the DST group (13.3%) (ns). No difference in the incidence of hypotension, postdural puncture headache, and back pain was observed between the two groups. Acceptance of anesthetic procedure was better in the SST (85%) than in the DST group (66.6%) (P <.05). Conclusions. The needle-through-needle technique for CSE requires less time, has no greater failure rate, and results in greater patient satisfaction than the double-segment technique. The use of a spinal needle with an adjustable locking mechanism and protruding up to 15 mm beyond the Tuohy needle improved successful spinal block in the needle-through-needle technique compared with previous reports.

AB - Background and Objectives. The goal of the present investigation was to compare the double-segment and the needle-through-needle techniques for combined spinal and epidural anesthesia (CSE) in a prospective, randomized, blinded study. Methods. With Ethical Committee approval and patient's consent, 120 patients were randomized to receive CSE by the needle-through- needle (SST; n = 60) or the double-segment technique (DST; n = 60). A blind observer measured the time required from skin disinfection to readiness for surgery (loss of pinprick sensation up to T10), failure of dural puncture, need for epidural top-up before surgery, patient acceptance, and occurrence of complications. Results. No neurologic complications were observed in either group. Time to readiness for surgery was 22.7 ± 8.2 minutes in the SST group and 29.8 ± 8.31 minutes in the DST one (P <.001). Dural puncture was unsuccessful in three patients in the SST group (5%) and in one patient in the DST group (1.6%) (ns); inadequate spread of spinal anesthesia was observed in five patients in the SST group (8.3%) and in eight patients in the DST group (13.3%) (ns). No difference in the incidence of hypotension, postdural puncture headache, and back pain was observed between the two groups. Acceptance of anesthetic procedure was better in the SST (85%) than in the DST group (66.6%) (P <.05). Conclusions. The needle-through-needle technique for CSE requires less time, has no greater failure rate, and results in greater patient satisfaction than the double-segment technique. The use of a spinal needle with an adjustable locking mechanism and protruding up to 15 mm beyond the Tuohy needle improved successful spinal block in the needle-through-needle technique compared with previous reports.

KW - Epidural anesthesia

KW - Regional anesthesia

KW - Spinal anesthesia

UR - http://www.scopus.com/inward/record.url?scp=0031823898&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031823898&partnerID=8YFLogxK

M3 - Article

C2 - 9690592

AN - SCOPUS:0031823898

VL - 23

SP - 390

EP - 394

JO - Regional Anesthesia and Pain Medicine

JF - Regional Anesthesia and Pain Medicine

SN - 1098-7339

IS - 4

ER -