The analysis of tissue coring of epithelial cells in spinal block performed with 25-gauge Pencil-point and Ballpen® spinal needles

Abstract

During lumbar puncture for spinal anaesthesia, the needle may carry tissue cores into the subarachnoid space, with the potential complication of intraspinal lumbar epidermoid tumour. Coring is believed to occur not only with hollow needles, but even with newer styletted spinal ones. This prospective randomised, blinded study was undertaken to analyse the tissue coring of epithelial cells with the new Ballpen® spinal needles, and the more widely used Pencil-point spinal needles. Forty patients undergoing spinal anaesthesia for transurethral prostate resection were randomized into two groups according to the spinal needle type. Spinal anaesthesia was performed with Pencil-point 25-gauge and Ballpen® 25-gauge spinal needles with the aid of 20-gauge introducer needle. After removal of the stylette, 1 ml of cerebrospinal fluid was collected by free-flow into a sterile test tube, and investigated under the light microscope by a pathologist blinded to the type of needle. Any sample containing at least one nucleated squamous epithelial cell was considered as positive (+) for tissue coring. Four samples from the 19 Pencil-point needles (21%) and one sample from the 15 Ballpen® needles (7%) contained benign squamous epithelial cells (ns). It was concluded that both 25-gauge Ballpen® and Pencil-point spinal needles produce epithelial tissue coring, unaffected by use of an introducer needle and stylette. © 2006 VSP.