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B189 When the dura gets tough, the tough gets going
  1. B Marques,
  2. R De Oliveira,
  3. I Aguiar,
  4. B Oliveira,
  5. A Morais and
  6. M Ferreira
  1. Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal


Background and Aims Advancements in continuous spinal anaesthesia (CSA) equipment have been made, however, due to equipment inaccessibility, many institutions resort to epidural sets1. We present a patient undergoing hip arthroplasty under CSA. Multiple unsuccessful attempts to access the intrathecal space (ITS) with a Tuohy needle were made. After an attempt with an 18-gauge spinal needle, the catheter was successfully threaded easily. In institutions that use epidural sets for CSA, lower gauge spinal needles may be successful alternatives to access the ITS when difficulties are encountered.

Methods Elderly female with aortic stenosis undergoing hip arthroplasty with CSA. Loss of resistance with an 18-gauge Tuohy needle was detected at 4cm. After unsuccessful attempts to access the ITS, an 18-gauge spinal needle was successfully advanced and a 20-gauge catheter introduced. Surgery was uneventful. She was discharged without cardiovascular complications or post-dural puncture headache (PDPH).

Results Differences in needle-tip design may have played a major role (Figure 1). Age-related calcifications of the dura-mater may hamper dural puncture with a Tuohy needle’s gentle curved blunt bevel. A lower gauge spinal needle with a cutting bevel can access the ITS by facilitating dural tear, however, lack of markings make precise determination of the ITS-skin distance impossible. PDPH is a concern2, however, it was not experienced, possibly due to lower incidences in the elderly and catheter-induced inflammatory reaction concealing the dural tear3.

Conclusions There is insufficient experience and evidence to suggest which intrathecal systems achieve best results1, nevertheless, lower gauge spinal needles may be alternatives when difficulties are encountered with technique performance.

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