Imbelloni LE, Sales MBL (2018) Accidental Perforation of Subarachnoid Space with Spinal Introducer. Int J Anesthetic Anesthesiol 5:074.


© 2018 Imbelloni LE, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

CASE REPORT | OPEN ACCESS DOI: 10.23937/2377-4630/1410074

Accidental Perforation of Subarachnoid Space with Spinal Introducer

Luiz Eduardo Imbelloni1*and Micaela Barbosa L Sales2

1Anesthesiologist, Hospital de Trauma, João Pessoa, Brazil

2Anesthesiology, Resident, Hospital de Trauma, João Pessoa, Brazil



The existence of fine gauge needles with a traumatic bevel, pencil tip type; it is possible to increase the indication of spinal anesthesia in young people and to reduce the incidence of post-puncture headache. We present a case of a post-dural puncture headache occurring after perforation dura mater using a 20-gauge needle introducer for spinal anesthesia with Whitacre needle.

Case report

A 34-year-old man (body weight 67 kg, height 176 cm, ASA I) with right femoral diaphysis fracture. After analgesia with inguinal lumbar plexus block, spinal anesthesia using a 20G needle introducer before inserting the 27G Whitacre needle. At first attempt, removal of the Whitacre stylet demonstrated CSF completely filling the needle hub. The introducer needle was withdrawn immediately. New punction was performed at L4-L5 level and single lumbar puncture via median with 27G Whitacre needle through the 20G introducer guide. After dripping of CSF, 15 mg of 0.5% isobaric bupivacaine was administered. After 48 hours the patient reported PHDP. Within three days the postural headache settled with conservative treatment consisting of oral analgesia while maintaining adequate hydration.


The introducer needle does carry the risk of accidental dural puncture, and this fact happened in our patient using the 20G introducer of 35 mm in length resulting in severe headache and lasting for three days.