P029: BROKEN SPINAL NEEDLE IN A PARTURIENT UNDERGOING A CESAREAN SECTION
Grace Chalhoub, DO; Sarah Mathews, CRNA; Benjamin Houseman, MD, PhD; Maria Frosth, MD; Thomas Windisch, MD; Department of Anesthesiology, Memorial Healthcare System, Florida
Introduction and Case Report: Needle fracture is a rare complication of spinal anesthesia in parturients. A review of the literature suggests that both patient factors (positioning, BMI, anatomic landmarks) and procedural factors (number of attempts, needle gauge, urgency of procedure) contribute to the likelihood of needle fracture.1-3 Below we describe a case of needle fracture that occurred during a single attempt at spinal anesthesia in a parturient scheduled for cesarean section.
A 27 yo G1P0 at 40 4/7 weeks with no known allergies, no significant past medical history and a BMI of 43 was admitted for induction of labor. Soon after induction was begun, a decision was made to proceed with cesarean section due to non-reassuring fetal heart tones. She was placed in a seated position in the operating room, and a 24G Sprotte spinal needle and 20G introducer needle were utilized to attempt midline spinal anesthesia at the L3-4 interspace. When the attempt was unsuccessful, the spinal and introducer needles were removed en bloc, but the spinal needle appeared shortened and needle fracture was suspected (Figure 1A). The team was informed and a combined spinal epidural technique (17G Tuohy, 24G Sprotte) was utilized to inject 1.3 mL of 0.75% bupivacaine intrathecally at the L2-3 level. The case proceeded uneventfully, and a baby girl with Apgar scores of 8 and 9 was delivered.
CT scan of the patient’s lumbar spine later that day revealed a 44 x 2 mm needle fragment in the L3-4 interspace (Figure 1B). Neurosurgery was consulted, and the fragment was removed uneventfully under general endotracheal anesthesia on postpartum day 1. Both mother and baby were discharged home on postpartum day 3.
Discussion: Case reports involving spinal needle fracture commonly describe multiple attempts in which the needle undergoes strain or torque while partially inserted in a patient.1-3 This case report is notable because the needle fracture occurred during an initial attempt at the L3-4 interspace. Other than BMI 43, there were few factors increasing risk for needle fracture. We elected to proceed with a second attempt at the L2-3 interspace because the team felt that it was superior to general anesthesia in this parturient.4
Although our patient had no back pain or other symptoms, a retained needle fragment can have many potential consequences including migration into adjacent tissue, infection or fibrosis of surrounding tissue, nerve damage, and CSF leakage.1-3 Prompt evaluation and removal of the retained needle fragment is recommended for optimal outcomes.
- Martinello C, et al. J Clin Anesth. 2014 Jun;26(4):321-4.
- Kaboré RAF, et al. Local Reg Anesth. 2018;11:111-113.
- Shah SJ et al, Case Reports in Anesthesiology, vol. 2020, Article 8880464
- Taylor CR, et al. Local Reg Anesth. 2019 Nov 18;12:111-124.