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A Modified Needle with a Blunt Tip for Sympathetic Blocks in Abdominal and Pelvic Pain
A Novel Approach to Interventional Pain Management

 

DK Baheti

 

The new 20 gauge blunt tip needle was used for sympathetic block in ninety four cases of chronic abdominal and pelvic pain.
The procedures were sixty five coeliac plexus block; twenty seven lumbar sympathectomy and two cases of superior hypo gastric plexus block.
There was no incidence of iatrogenic complications such as injury or puncture of any vessel or internal organs in this series.

Introduction
The routine use of a 6 inches or a 15 cm long
needles (sharp tip or short bevel) may results in an iatrogenic puncture of an internal organ like vein, pleura, peritoneum etc., and these iatrogenic complications have been reported in the literature from time to time.

The iatrogenic complication reported during coeliac plexus blocks are pneumothorax (two cases) by Brown (1987); partial lower extremity paralysis (One case) by Thomson et al (1977); temporary paraplegia (One case) by Baheti (2001).

While performing lumbar sympathectomy Boas (1978) reported 6% incidence of genitofemoral neuralgia, Cousins and associates (1979) reported 35 patients with mild or severe neuralgia.

Other complications such as backache, intravascular or subarachnoid injection, neuralgia, muscle spasm are mentioned by P Raj et al (2003).

Iatrogenic complications such as chylothorax, pleural effusion, renal injury and injury to veins also have been reported.

The role of sharp needle in above complications can not be ruled out.

Aims of Investigations
The new blunt tip needle was used to minimize the procedure related complications to major vessels/organs during the sympathetic blocks for intractable abdominal and pelvic pain.


Fig. 1 : Blunt tip needle

Material and Methods
Blunt Tip Needle
The above is a 6 inch long, 20 gauge, and stainless steel needle with blunt tip. It can be easily autoclaved (Fig. 1).

The needle was used in ninety four cases of sympathetic blocks. The series included sixty five cases of coeliac plexus block and twenty seven cases of lumbar sympathectomy and two cases of superior hypo gastric plexus block.

To facilitate skin puncture either an 18 gauge hypodermic needle or 11 no. surgical blade was used. Once deep fascia was pierced, no difficulty was encountered in inserting the needle to the point of destination.

The indications for the procedures are mentioned in Table 1.

Conclusions
We found that the new blunt tipped needle is very useful. As there were no iatrogenic complications such as puncture of vessels or injury to internal organs found in this series.

However, a large number of cases require to be done with this needle, to substantiate the claim.

The same principle of blunt tip needle can be applied for transforaminal epidural, to avoid injury to epidural vessels. The author is already working on the same.

This needle has been successfully used in seventy cases (coeliac plexus block-50 and lumbar sympathectomy-20) and a report was submitted on, 2nd January 2005 for 11th World Congress on Pain, 21-26 August 2005 at, Sydney.

The patent for above mentioned blunt tip needle is applied for.

Suggested Reading

  1. Brown DL, Bully CK, Quiel EC. Neurolytic celiac plexus block for pancreatic cancer pain. Anaesth Analg 1987; 66 : 869-73.
  2. Thompson GE, Moore DC, Braidenbaugh LD. Abdominal pain and alcohol celiac plexus block Anesth. Analg 1977; 56 : 1-5.
  3. Baheti DK. Neurolytic coeliac plexus block (NCPB): A ten year review of 212 cases. Bombay Hospital Journal 2001; Vol. 43, No. 1.
  4. Boas RA. Sympathetic blocks in clinical practice. In Stanton-Hicks M. Ed. International Anesthesia Clinics. Regional Anesthesia: Advances in selected topics. Boston. Little, Brown 1978; Vol. 16, No. 4.
  5. Cousins MJ, Reeve TS, Glynn CJ, et al. Neurolytic Sympathetic Blockade: Duration of denervation and relief of rest pain. Anesth. Intensive Care 1979; 7 : 121-35.
  6. Prithviraj P et al. Coeliac plexus block and neurolysis Radiographic Imaging for Regional Anesthesia and Pain Management. Churchill Livingston: 1003 : 164-74.
  7. Baheti DK. Use of new modified needle with blunt tip for neurolytic sympathetic block in abdominal malignancies - Abstracts 11th World Congress on Pain: IASP Press; 2005 : 489-90.

 


Chief, Pain Management Clinic, Bombay Hospital Institute of Medical Sciences, 12, New Marine Lines, Mumbai - 400 020, India.

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