Novel pulsatile cerebrospinal fluid model to assess pressure manometry and fluid sampling through spinal needles of different gauge: support for the use of a 22 G spinal needle with a tapered 27 G pencil-point tip

Br J Anaesth. 2012 Feb;108(2):308-15. doi: 10.1093/bja/aer372. Epub 2011 Dec 11.


Background: Parallel-walled spinal needles ≤ 22 G are routinely used for lumbar puncture, despite a reported ≥ 32% incidence of post-dural puncture headache. A tapered spinal needle (22 G shaft, 27 G tip) is in use in our institution. We hypothesized that despite the smaller dural puncture hole, this needle has similar cerebrospinal fluid (CSF) pressure equilibration times and CSF sampling times to a standard 22 G needle and assessed a range of spinal needles using an experimental pulsatile CSF reservoir.

Methods: The pulsatile CSF reservoir had an oscillating pressure varying between 25 and 15 cm H(2)O at a cycle frequency of 80 s(-1). We tested seven parallel-walled spinal needles (18-27 G) and the tapered 22/27 G needle. CSF pressure was measured every 2 s by manometry. The time to collect 1 ml CSF samples was measured. Saline 0.9% and mannitol 20% were tested separately. One-way ANOVA with Bonferroni post-hoc test was used to compare 22G, 27G and 22/27G needles.

Results: The mean [standard deviation (sd)] CSF pressure equilibration time (saline) was 40.7 (6.4), 108.7 (6.1), and 51.3 (4.6) s for the 22, 27, and 22/27 G needles (P< 0.0001 for comparisons between 27 G and other needles). The mean (sd) CSF sampling time (saline) was 40.3 (3.1), 225.3 (10.0), and 63.0 (5.2) s for the 22, 27, and 22/27 G needles (P< 0.0001 for comparisons between 27 G and other needles, and P= 0.019 between 22 and 22/27 G needles). Saline was different from mannitol for both measurements and all needles (P< 0.0001).

Conclusions: A 22/27 G tapered spinal needle has similar flow properties to the 22 G needle, despite a 27 G tip.

MeSH terms

  • Cerebrospinal Fluid Pressure / physiology*
  • Child
  • Equipment Design
  • Humans
  • Manometry / methods
  • Models, Neurological*
  • Needles* / adverse effects
  • Post-Dural Puncture Headache / etiology
  • Post-Dural Puncture Headache / prevention & control
  • Pulsatile Flow / physiology
  • Rheology
  • Spinal Puncture / adverse effects
  • Spinal Puncture / instrumentation*
  • Spinal Puncture / methods