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Anesth Analg 2005;101:535-540
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000157162.41892.6A

OBSTETRIC ANESTHESIA

A Comparison of Espocan® and Tuohy Needles for the Combined Spinal-Epidural Technique for Labor Analgesia

Ingrid M. Browne, MB, BCh, BAO, FFARCSI, David J. Birnbach, MD, Deborah J. Stein, MD, David A. O'Gorman, MD, FFARCSI, and Maxine Kuroda, MPH, PhD

Departments of Anesthesiology, University of Miami School of Medicine, Miami, Florida; and St. Luke's-Roosevelt Hospital Center, College of Physicians and Surgeons of Columbia University, New York, New York

Address correspondence to David J. Birnbach, MD, Department of Anesthesiology, University of Miami School of Medicine, 1611 NW 12th Ave., Miami, FL 33136. Address e-mail to dbirnbach{at}med.miami.edu.

When using the needle-through-needle combined spinal-epidural (CSE) technique for labor analgesia, failure to obtain cerebrospinal fluid (CSF), paresthesias, and intrathecal or intravascular migration of the catheter are of concern. Epidural needles with spinal needle apertures, such as the back-hole Espocan® (ES) needles, are available and may reduce these risks. We describe the efficacy and adverse events associated with a modified epidural needle (ES) versus a conventional Tuohy needle for CSE. One-hundred parturients requesting labor analgesia (CSE) were randomized into 2 groups: 50—ES 18-gauge modified epidural needle with 27-gauge Pencan® atraumatic spinal needle, 50—conventional 18-gauge Tuohy needle with 27-gauge Gertie Marx atraumatic spinal needle. Information on intrathecal or intravascular catheter placement, paresthesia on introduction of spinal needle, failure to obtain CSF through the spinal needle after placement of epidural needle, unintentional dural puncture, and epidural catheter function was obtained. No intrathecal catheter placement occurred in either group. Rates of intravascular catheter placement and unintentional dural puncture were similar between the groups. Significant differences were noted regarding spinal needle-induced paresthesia (14% ES versus 42% Tuohy needles, P = 0.009) and failure to obtain CSF on first attempt (8% ES versus 28% Tuohy needles, P < 0.02). Use of ES needles for CSE significantly reduces paresthesia associated with the insertion of the spinal needle and is associated with more frequent successful spinal needle placement on the first attempt.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.