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The PENCAN 25-Gauge Needle: A New Pencil-Point Needle for Spinal Anesthesia Tested in 1,193 Patients
  1. Erik J. Krommendijk*,
  2. Raymond Verheijen,
  3. Boudewijn van Dijk,
  4. Emiel M. Spoelder*,
  5. Mathieu J.M. Gielen and
  6. Jaap J. de Lange*
  1. *Department of Anesthesiology, Vrije Universiteit, Amsterdam, The Netherlands;
  2. Institute for Anesthesiology, University Hospital Nijmegan, The Netherlands;
  3. Department of Anesthesiology, Diaconessenhuis Voorburg, Voorburg, The Netherlands.
  1. Reprint requests: Erik J. Krommendijk, Department of Anesthesiology, Academic Hospital “Vrije Universiteit” P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.


Background and Objectives The PENCAN 25-gauge spinal needle is a new pencil-point needle with an inner diameter of 0.32 mm resulting in a relatively high cerebrospinal fluid (CSF) flow. The PENCAN 25-gauge needle was tested for ease of identification of a successful dural puncture, the failure rate of spinal anesthesia, and the incidence of postdural puncture headache (PDPH).

Methods In a multicenter trial, the needle was tested in patients undergoing spinal anesthesia. A questionnaire evaluated the characteristics of the dural puncture. A second questionnaire was used to assess postspinal side effects (PDPH, atypical headache, audiovisual disturbances).

Results In 1,193 patients, dural puncture was evaluated as easy in 85.2%, as moderate in 6.2%, as difficult in 6.7%, and as impossible in 1.9%. Needle performance was assessed as excellent or satisfactory in 96.9%. In 95.9% of patients, CSF appeared within 2 seconds. A perceptible “click” was noticed in 78.4% of patients. In 1.9%, CSF could not be obtained, because of spine deformities, obesity, or bending of the needle. In 1,166 patients, postpuncture complaints were evaluated, involving 635 women (54.5%), 773 patients (66.3%) under the age of 50 years old, and 170 (14.6%) cesarean deliveries. The overall incidence of PDPH was 1.3% (n = 15). A bloodpatch was needed in five patients. After cesarean delivery the incidence of PDPH was 3.4%, all responding to conservative treatment. Atypical headache and isolated audiovisual disturbances occurred in 7.5% and 1.5% of patients, respectively.

Conclusions A failure rate of 1.9% together with a 1.3% incidence of PDPH were comparable to other 25-gauge pencil-point needles. The rapid appearance of CSF and a perceptible “click” made prompt recognition of successful dural puncture possible. Reg Anesth Pain Med 1999: 24: 43–50.

  • failure rate
  • pencil-point needle
  • postdural puncture complaints.

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