Influence of needle diameter on spinal anaesthesia puncture failures for caesarean section: A prospective, randomised, experimental study.

OBJECTIVES: Spinal anaesthesia represents the technique of choice for elective caesarean section. The purpose of this study was to compare the puncture failure rates with 25, 26 or 27 gauge (G) pencil-point, Whitacre type (with introducer) needles during spinal anaesthesia for caesarean section. STUDY DESIGN: Prospective, randomised, experimental study in healthy subjects. PATIENTS AND METHODS: We recruited 330 adults, consecutively scheduled parturients, randomised into three groups. The subarachnoid puncture procedure was standardised. The flexibility of the three needle types was assessed in vitro, and a force was applied using a dynamometer. The occurrence of postdural puncture headache was also evaluated. RESULTS: The number of spinal puncture failures was significantly higher in the 27G group, than in the 25G (P=0.006) group and the 26G (P<0.001) group, but did not differ between the 25G and 26G groups (P=0.606). Ten postdural puncture headaches were observed without significant differences among the groups. CONCLUSIONS: This prospective study showed that puncture failures occur less frequently with the use of 25G or 26G pencil-point needles as compared to 27G needles, probably due to the higher flexibility of the latter. This characteristic was demonstrated in vitro, in a reproducible model. This experiment suggests that a 26G pencil-point needle is the optimal gauge for performing spinal anaesthesia for scheduled caesarean sections.

Giant retroperitoneal leiomyoma: a case report and review of the literature.

UNLABELLED: Retroperitoneal leiomyomata are infrequent, and their prevalence among primary retroperitoneal tumours has been estimated as 0.5-1.2%. The authors report a case of symptomatic retroperitoneal leiomyoma with a favourable prognosis. A 53-year-old woman presented for abdominal pain associated to an inflammatory syndrome. A contrast-enhanced computed tomography revealed a large abdominopelvic mass and patient underwent open surgical excision. Definitive diagnosis was done after immunohistochemical assessment. Immunoreactivity was strong for smooth muscular actin. Presence of oestrogen and progesterone receptor proteins was also detected. Prognosis of these well-differentiated smooth muscle tumours is generally favourable but a postoperative surveillance is always recommended. KEY WORDS: Leiomyoma, Retroperitoneal space, Surgery.

Short-stay hospitalisation for benign thyroid surgery: a prospective study.

We report our prospective experience of short-stay hospitalisation for benign thyroid surgery. Post-operative outcome, complication rate and duration of hospitalisation were evaluated for 200 similar patients with bilateral multi-nodular goitres treated surgically by total thyroidectomy. All subjects gave written informed consent. A short-stay regimen, with discharge within 24 h of admission, was possible in 92.5 %. Fourteen (7 %) were discharged on the second post-operative day and one on the fourth post-operative day. Causes of the 15 delayed discharges beyond 24 h were 11 hypocalcaemia (5.5 %), 3 haematoma (1.5 %) and 1 dysphonia (0.5 %). All compressive haematoma were treated by urgent reoperation. No mortality occurred. None required tracheostomies. Transient complications were diagnosed in 36 cases: 25 with hypocalcaemia and 11 with recurrent laryngeal nerve injuries. Permanent complications were observed in three patients: two with hypoparathyroidism and one with nerve damage. All patients were carefully counselled about potential thyroid surgery complications and a 24-h emergency-contact number was provided. Short-stay hospitalisation represents safe and cost-saving surgical management for benign thyroid surgery.