Article Figures & Data
Figures
- Figure 1.
Published rates of unintended Tuohy needle dural puncture in obstetric patients receiving continuous epidural or combined spinal-epidural anesthesia from 1972 to 2021. Vertical lines show unintended dural puncture rate ranges when the authors reported rates differentiated by performer experience (• novice, •• resident, ••• fellow or registrar, •••• faculty/staff); by facility (max [maximum], rate at the hospital with the highest rate; min [minimum], rate at the hospital with the lowest rate); or by practitioner annual case volume (vol) (high-vol, high caseload volume; low-vol, low caseload volume). Bracketed numbers below publication dates are the articles’ reference list numbers. Open and black circles, open triangles, and the asterisk are series means except for the triangle in parentheses that is from a published series that reported maximum and minimum unintended dural puncture rates but no mean value. ASA, American Society of Anesthesiologists.
- Figure 2.
Resistance to fluid (saline or local anesthetic solution) injection as subjectively measured by the operator inserting a Tuohy needle during performance of combined spinal-epidural anesthesia or continuous epidural anesthesia. (A) Serial Tuohy needle tip and end orifice positions during insertion into the dorsal lumbar midline. (B) Depiction of the distance from the skin to the epidural space (ES) as the sum of the distance from the skin to the supraspinous ligament (SSL) (DS→SSL) plus the distance from the SSL to the ES (DSSL→ES). (C) Graph of serial subjective measurements of resistance to fluid injection through the Tuohy needle as the needle tip was advanced from the skin to the ES. A single episode of false-positive loss of resistance is depicted by the asterisk. CSF, cerebrospinal fluid; DM, dura mater; ES, epidural space; ISL, interspinous ligament; L3-PSP, posterior spinous process of the third lumbar vertebra; L4-PSP, posterior spinous process of the fourth lumbar vertebra; LF, ligamentum flavum; S, skin; SC, subcutaneous layer; SSL, supraspinous ligament.
- Figure 3.
Smart phrase addendum to the electronic medical record default combined spinal-epidural anesthesia procedure note. ht, height; LOR, loss of resistance; Pt, patient; SSL, supraspinous ligament; wt, weight.
- Figure 4.
Frequency of occurrences of false-positive loss of resistance to fluid injection expressed as percentage of 136 parturients receiving combined spinal-epidural anesthesia.
- Figure 5.
Epidural space depth measured deep to supraspinous ligament (SSL) (upper graph) and deep to skin (lower graph) in the same 84 parturients.
- Figure 6.
Number of 1- to 2-mm Tuohy needle advancements required to insert the catheter through the Tuohy needle into the epidural space after spinal anesthesia was performed in 236 parturients.
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