BACKGROUND AND OBJECTIVES: After fine spinal needles (26G, 27G and 29G) introduction and consequent decrease in post dural puncture headache, spinal anesthesia is being increasingly used. Its complications are uncommon however recently we have observed a seemingly unusual complication: needle fracture during spinal puncture. This report aimed at describing the fact and at pointing its possible causes in addition to its prevention. CASE REPORT: Male patient, 53 years old, 90 kg, 175 cm, with chronic systemic hypertension and renal failure presented for emergency renal transplantation. Spinal morphine was proposed for postoperative analgesia. Puncture at L3-L4 with 27G needle was attempted without success, and was followed by attempt at L2-L3 when needle deformation was observed. Needle has broken at removal, leaving behind a 43 mm fragment in the L2-L3 interspinous ligament, which was confirmed by fluoroscopy. General anesthesia was induced and fragment was removed by fluoroscopic surgical exploration. Renal transplantation was then performed uneventfully. CONCLUSIONS: Decreased needle gauge has decreased post dural puncture headache but has also made needles fragiles. When ligaments are more resistant and puncture is attempted more than once there may be material stress leading to needle fracture. In conclusion, when there is increased resistance to needle introduction and puncture difficulty, the risk of deformation and potential fracture should be balanced against fine needle advantages.
BACKGROUND AND OBJECTIVES: After fine spinal needles (26G, 27G and 29G) introduction and consequent decrease in post dural puncture headache, spinal anesthesia is being increasingly used. Its complications are uncommon however recently we have observed a seemingly unusual complication: needle fracture during spinal puncture. This report aimed at describing the fact and at pointing its possible causes in addition to its prevention. CASE REPORT: Male patient, 53 years old, 90 kg, 175 cm, with chronic systemic hypertension and renal failure presented for emergency renal transplantation. Spinal morphine was proposed for postoperative analgesia. Puncture at L3-L4 with 27G needle was attempted without success, and was followed by attempt at L2-L3 when needle deformation was observed. Needle has broken at removal, leaving behind a 43 mm fragment in the L2-L3 interspinous ligament, which was confirmed by fluoroscopy. General anesthesia was induced and fragment was removed by fluoroscopic surgical exploration. Renal transplantation was then performed uneventfully. CONCLUSIONS: Decreased needle gauge has decreased post dural puncture headache but has also made needles fragiles. When ligaments are more resistant and puncture is attempted more than once there may be material stress leading to needle fracture. In conclusion, when there is increased resistance to needle introduction and puncture difficulty, the risk of deformation and potential fracture should be balanced against fine needle advantages.