This document discusses the history and types of spinal and epidural needles. It begins by introducing regional anesthesia and the importance of needles. It then describes the development of spinal needles over time from Quincke's original design to modern pencil-point needles. Key spinal needle types including Quincke, Whitacre, and Sprotte are outlined. Epidural needles including Touhy and Crawford designs are also summarized. Complications related to needle placement are briefly mentioned. The document emphasizes that needle design modifications have improved techniques like spinal and epidural anesthesia.

1. SPINALAND EPIDURAL
NEEDLES
- Dr ZIKRULLAH

2. INTRODUCTION
Regional anaesthesia makes a specific part of
the body numb to relieve pain or allow surgical
procedures to be done
It is often used for orthopaedic surgery on an
extremity, for male/female reproductive
surgery, and for operations on urinary bladder
and tract.
Needles are the most important equipment
used in administration of regional anaesthesia.

3. REGIONAL ANAESTHESIA
NEURAXIAL
TECHNIQUES
PERIPHERAL TECHNIQUES
SPINAL
ANAESTHESIA
EPIDURAL
ANAESTHESIA
PLEXUS
BLOCK
NERVE BLOCK

4. Spinal and Epidural neuraxial blocks are
forms of regional anaesthetic techniques,
that result in –
• sympathetic blockade ,
• sensory analgesia and
• motor paralysis
depending upon the dose, concentration and
volume of local anaesthetic injected after the
insertion of a needle in the plane of neuraxis
.

5. SPINAL NEEDLES

6. HISTORICAL OVERVIEW
• 1891 - Quincke first described the technique
of lumbar puncture. He used a needle which
was sharp, bevelled and hollowed.

7. 1898 - The next major step in the h/o spinal
anaesthesia was the work of German surgeon
Augustus Bier .

8. Over time, Augustus developed a large
bore needle (15G to 17G),with a long,
cutting bevel & sharp point.
But, Bier’s needle was criticized on
account of causing pain on insertion &
leaving large hole in the dura.

9. • In 1914 – Babcock described a needle with
a finer cannula to limit the incidence of
PDPH. It was very successful needle design
& became the standard spinal needle for
comparative studies .

10. • In 1923 – Another important modification
in the h/o development of spinal needle
took place, which was change in its tip
design . H.E. Greene used an ordinary
23G cutting needle that he sharpened to
a rounded tip by removing the cutting
edges of the bevel .

11. • Greene needle
In 1932 - needle with closed end with a lateral
orifice was developed.

12. • In 1944 - Tuohy used a 15G directional
spinal needle through which he passed
a nylon ureteric catheter into the
subarachnoid space to allow
continuous spinal anaesthesia .

13. • 1951 - Whitacre needle came into light
in 1951. But it had problems like small
orifice & that its stylet could not occlude
the orifice, which could therefore became
blocked with tissues .

14. • In 1987 – Sprotte modified Whitacre
needle by increasing the size of the
distal orifice to combat the
problems of slow CSF flow . But
Sprotte’s needle had drawback of
incomplete block due to loss of
anaesthetic drug in subdural space.

15. • In 1996 - latest change in the design
of spinal needle occurred when
Eldor designed a pencil point
needle with two lateral holes . The
idea behind this design was to allow
rapid flow of CSF and more even
distribution of local anaesthetics .

16. DESCRIPTION
• Spinal needles are available in an array of
–Sizes (16G-30 G)
–Length
–Bevel &
–Tip design
Various sizes are made ranging from 16G to
30G in diameter.
• 32G needle is also described but are not widely
used.
• Length varies from 5-15 cm, but 9 cm version
is most commonly used.

17. Standard Spinal needle consists of 3 parts :
1. Hub
2. Cannula
3. Stylet

18. GENERAL PROPERTIES :
• Spinal needles are carefully manufactured
without surface irregularities, with a tight
fitting removable stylet that completely
occludes the needle lumen.
• Stylet avoids the tracking of epithelial cells
into subarachnoid space and it also
provides strength to the shaft of needle.

19. • Points of cannulae are made of stainless
steel as it meets standards of
stiffness and flexibility and also has
resistance to breakage .

20. TYPES
QUINCKE NEEDLE WHITACRE NEEDLE
PITKIN NEEDLE SPROTTE NEEDLE
GREENE NEEDLE
ACCORDING TO THE
TIP- DESIGN
SHARP / CUTTING
TIP NEEDLE
BLUNT – TIP / PENCIL
– POINT NEEDLE

21. ADVANTAGES of pencil point needle
over cutting tip needle are :
1. They are less taumatic .
2. They are dura separating NOT dura
cutting .
3. Has lesser incidence of PDPH .

22. QUINKCE NEEDLE WHITACRE NEEDLE
GREENES NEEDLE SPROTTE NEEDLE
PITKIN NEEDLE
ACCORDING TO THE SITE OF
HOLE
END-INJECTION
NEEDLE
SIDE- INJECTION
NEEDLE

23. 1. QUINCKE-BABCOCK NEEDLE
–It is the standard or traditional needle .
–Has a medium bevel length with sharp
edges, a sharp point and it is an end -
injection needle .

24. • Caution should be taken that bevel
remains parallel to the dural fibres .
• Quincke needle comes in various sizes
:
29G x 3.5” (0.34 x 90mm)
27G x 3.5” (0.41 x 90mm)
26G x 3.5” (0.45 x 90mm)
23G x 3.5” (0.60 x 90mm)

25. 2. WHITACRE NEEDLE
–It is a “Pencil point” needle.
–Has small sized non–cutting bevel .

26. • Whitacre needle has solid tip .
• Has side injection .
• Opening is 2 mm proximal to tip .
• Has lesser chances of PDPH as
compared to Quincke’s needle .
• Whitacre needle also comes in
various sizes :-
27G x 3.5˝ (0.41 x 90mm)
26G x 3.5˝ (0.45 x 90mm)
24G x 3.5˝ (0.55 x 90mm)
22G x 3.5˝ (0.60 x 90mm)

27. 3. SPROTTE NEEDLE
• It is a modification of Whitacre needle .
• It has a blunt non-cutting bevel .
• Opening of the hole is wider than the
needle diameter.
• Has an advantage of more vigorous CSF
flow compared with similar gauge needle.

28. • The wider hole also allows greater
mixing of the local anaesthetic solution
with the CSF & to allow more even
distribution of local anaesthetic
solution in the subarachnoid space .
• The tip of the Sprotte needle is
elongated to facilitate more gradual
separation of dural fibres & therefore
less CSF leakage and a decreased
incidence of PDPH.

29. • Disadvantage of this needle is that the
size of the lateral hole sometimes
causes the orifice to straddle the dural
layers , resulting in partial loss of
local anaesthetic solution and
incomplete block .
• The width of the hole also leaves the
distal portion of the tip relatively
prone to damage including fracture .

30. 4. GREENE’S NEEDLE:
• Has a long bevel with rounded point and sharp
bevel with end injection.
5. PITKIN NEEDLE:
• Has a short sharp bevel and pointed end
injection.
6. TOUHY NEEDLE:
• Its an epidural needle that has application in
spinal anaesthesia for catheter placement for
continuous technique.

31. • Its hub is made transparent usually to
identify quickly the flow of CSF.
• Continuous spinal anaesthesia can be
achieved by inserting 3-4 cm of 28G nylon
open ended spinal micro catheter into
subarachnoid space.

32. EPIDURAL NEEDLE
CHARACTERISTICS :
Standard epidural needle is typically
• 17-18G in diameter
• 3-3.5 inches long
• has a blunt bevel
• with a gentle curve of 15-300 at tip .

33. TYPES
Epidural needles are mainly of four
types :
1. Touhy needle
2. Hustead needle
3. Crawford needle
4. Weiss needle

34. 1. TUOHY NEEDLE
most commonly used

35. –Has blunt, curved tip which helps to push
away the dura after penetrating ligamentum
flavum .
–The curved tip is referred to as HUBER tip.
–Needle wall is thin to allow insertion of
catheter.
–It is provided with a stylet introducer to
prevent occlusion of the lumen.
–Some designs allow the wings at the hub to
be added or removed .

36. • Markings on the needle helps to
determine the distance between skin
and the epidural space , and thus the
length of catheter to be left inside the
epidural space .
• Shape and design of the bevel helps to
direct catheter within the epidural
space (either cephalad or caudal) .

37. • Winged needles have better control and
handling during insertion .
• Combined spinal epidural technique is
possible using a 26G spinal needle of
about 12 cm in length with a standard 16
G Touhy needle .

38. 2. CRAWFORD NEEDLE
• It is straight needle without a curved
tip .
• Has short bevel with smooth edges .
• It is also a thin walled needle .
• Catheter emerges straight from the
tip .
• Has higher incidence of dural puncture .
• But facilitates passage of epidural
catheter .

40. 3. HUSTEAD NEEDLE
• It was a further modification of Touhy
needle .
• The needle opening did not exceed 2.7mm
in length .
• Needle bevel had an angle of 12 to 15° .
• In addition , the heel of the needle bevel
was smoothened to reduce the danger of
trapping and cutting the catheter should it
had to be withdrawn .

41. 4. WEISS NEEDLE
• It is a newer disposable epidural needle
.
• Had Touhy / Huber configuration .
• It also has metal wings at the junction
of shaft with the hub .
• “WINGS” make it easier to grasp the
needle with both hands for placement .

43. EPIDURAL CATHETER
• The use of plastic
Epidural catheter
was first described
by Flowers et al
in 1949.

44. • Epidural catheter is a fine tube which
is inserted into the epidural space
around the spinal cord , for the
administration of an anaesthetic agent .
• The catheter is passed into the
epidural space via a wide - bore needle
passed between two vertebrae of the
lower lumbar spine .

45. • It is a 90 cm transparent, malleable
tube made of either nylon or teflon and
is biologically inert .
• Single port at end or multiple side ports
close to the tip may be present.
• The distal end of the catheter is clearly
marked at 5 cm intervals with an
additional 1 cm markings between 5
and 15 cm.

46. • Proximal end of catheter is connected
to a luer lock and a filter.
• Spiral wire reinforced catheters, are
also available to avoid kinking.

47. • Some designs are radio - opaque .
• Catheters with a single port at tip offer a
sharp point and increase incidence of
catheter induced vascular or dural
puncture .
• Epidural fixing device can be used to
prevent the catheter from being pulled out .

48. FILTER
• An epidural catheter also has filter
attached to its proximal end .
• It has a 0.22 micron mesh which acts
as a bacterial , viral and foreign body
(e.g. glass) filter .
• And it should be changed every 24 hrs .

49. LOR SYRINGES (Loss Of Resistance) :
• It is another equipment used during
epidural catheter insertion .
• Has a special low resistance plunger used to
identify the epidural space by loss of
resistance technique .
• Its plastic and glass version are also
available .

51. COMPLICATIONS OF NEURAXIAL BLOCKS
RELATED TO NEEDLE / CATHETER
PLACEMENT
COMPLICATIONS
INFECTION
TRAUMA - BACKACHE,
PDPH
NERVE INJURY
INFLAMMATION
CATHETER
SHEARING /
MISPLACEMENT
BLEEDING
MISPLACEMENT

52. Incidence of PDPH is directly proportional
to the gauge of needle .
Approximately 30% incidence of PDPH
occur while using 20G needle .
And nearly 1% incidence of PDPH
occurs with 26G needle .
Also decreased PDPH is seen with dura
separating Whitacre and Sprotte needles
than with dura cutting needles .

53. REMARKS
• The spinal & epidural anaesthesia ,
which were once thought to be
impractical and cumbersome , has
become an essential part of today’s
anaesthetic practice .
• Part of this success can be attributed
to the modifications in needle design
and material made over the years by
the pioneering developers of these
needles .