Dry spinal tap during real-time ultrasound-guided paramedian spinal injection with patient in the lateral decubitus position: A single-centre retrospective study
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AbstractBackground
Real-time ultrasound-guided (USG) spinal injection is generally performed via the paramedian sagittal oblique (PMSO) ultrasound window.
Objective
The aim of this retrospective study was to draw attention to the occurrence of ‘dry tap’ during real-time USG spinal injection.
Design
Single-centre retrospective study.
Setting
University teaching hospital, Hong Kong, China
Patients
Data from 113 patients (aged 69.2 ± 18.0 years and BMI 22.3 ± 3.6 kg m−2) of American Society of Anesthesiologists physical status 1 to 3 scheduled for surgery under neuraxial blockade between 2007 to 2017 were reviewed.
Interventions
Real-time USG spinal injections or combined spinal-epidural (CSE) using the PMSO ultrasound window with the patient in the lateral decubitus position and the spinal needle inserted from the nondependent side were studied.
Main Outcome Measures
‘Dry tap’ was defined as a failure of cerebrospinal fluid (CSF) to efflux from the hub of the needle, within 3 min, with the spinal needle visualised sonographically within the thecal sac. ‘Slow CSF efflux’ was defined as efflux of CSF within 1 to 3 min. Irrespective of whether it was a ‘dry tap’ or ‘slow CSF efflux’, the planned dose of local anaesthetic was injected through the spinal needle.
Results
The combined incidence of ‘dry tap’ and ‘slow CSF efflux’ was 23.8% (27/113) with an individual incidence for each event of 9.7% (11/113) and 14.2% (16/113), respectively. Under the conditions of this study, successful spinal anaesthesia developed in all patients.
Conclusion
‘Dry tap’ occurs in 9.7% of cases during real-time USG spinal injection using the PMSO ultrasound window, with the patient in the lateral decubitus position and the spinal needle inserted from the nondependent side.
TRIAL REGISTRATION
ChiCTR-IOR-1800019011, Chinese Clinical Trials Registry (www.chictr.org.cn).
Real-time ultrasound-guided (USG) spinal injection is generally performed via the paramedian sagittal oblique (PMSO) ultrasound window.
Objective
The aim of this retrospective study was to draw attention to the occurrence of ‘dry tap’ during real-time USG spinal injection.
Design
Single-centre retrospective study.
Setting
University teaching hospital, Hong Kong, China
Patients
Data from 113 patients (aged 69.2 ± 18.0 years and BMI 22.3 ± 3.6 kg m−2) of American Society of Anesthesiologists physical status 1 to 3 scheduled for surgery under neuraxial blockade between 2007 to 2017 were reviewed.
Interventions
Real-time USG spinal injections or combined spinal-epidural (CSE) using the PMSO ultrasound window with the patient in the lateral decubitus position and the spinal needle inserted from the nondependent side were studied.
Main Outcome Measures
‘Dry tap’ was defined as a failure of cerebrospinal fluid (CSF) to efflux from the hub of the needle, within 3 min, with the spinal needle visualised sonographically within the thecal sac. ‘Slow CSF efflux’ was defined as efflux of CSF within 1 to 3 min. Irrespective of whether it was a ‘dry tap’ or ‘slow CSF efflux’, the planned dose of local anaesthetic was injected through the spinal needle.
Results
The combined incidence of ‘dry tap’ and ‘slow CSF efflux’ was 23.8% (27/113) with an individual incidence for each event of 9.7% (11/113) and 14.2% (16/113), respectively. Under the conditions of this study, successful spinal anaesthesia developed in all patients.
Conclusion
‘Dry tap’ occurs in 9.7% of cases during real-time USG spinal injection using the PMSO ultrasound window, with the patient in the lateral decubitus position and the spinal needle inserted from the nondependent side.
TRIAL REGISTRATION
ChiCTR-IOR-1800019011, Chinese Clinical Trials Registry (www.chictr.org.cn).
All Author(s) ListSomani S, Areeruk P, Mok LYH, Samy W, Sivakumar RK, Karmakar MK
Journal nameEuropean Journal of Anaesthesiology
Year2021
Month3
Volume Number38
Issue Number3
PublisherLippincott, Williams & Wilkins
Pages259 - 264
ISSN0265-0215
LanguagesEnglish-United Kingdom
