In situ abgebrochene 27-Gauge-Spinalnadel bei einer Re-Resectio

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• 作者：PD Dr. med. A. D. Rieg ; A. Dortgolz ; S. Macko ; R. Rossaint ; G. Schälte
• 关键词：SchlüsselwörterIn ; situ ; Bruch ; Spinalnadel ; neuroaxiale Blockade ; Komplikationen
• 刊名：Der Anaesthesist
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：66
• 期：2
• 页码：115-121
• 全文大小：
• 刊物类别：Medicine
• 刊物主题：Anesthesiology; Emergency Medicine; Intensive / Critical Care Medicine; Pain Medicine;
• 出版者：Springer Medizin
• ISSN：1432-055X
• 卷排序：66

文摘

We report the rare case of an in situ fracture of a spinal needle within the setting of repeated caesarean delivery in a 28-year-old pregnant woman and discuss the responsible underlying factors. In particular, a wrong technique, limited experience, difficulties to identify the anatomical landmarks, as well as the use of spinal needles smaller than 25 G might promote such a complication. In order to ensure the stability of the spinal needle and to avoid an in situ fracture, the spinal needle should be never moved without the stylet. In case of repeated bone contact, a well-experienced anaesthetist should be consulted, the spinal needle should be replaced and the use of ultrasound is recommended. Next, the use of an atraumatic spinal needle greater than 27 G should be considered to facilitate intrathecal puncture and to avoid the in situ fracture of a spinal needle. Within this context, the risk of post-spinal puncture headache should be balanced. If an in situ fracture of a spinal needle happens, its subsequent removal should be planned without delay by an interdisciplinary team and the anaesthetic method should be chosen with consideration of patient-specific risk factors.