A: It is a double hole pencil point spinal needle.

A: - Double Orifice area allows at least two times a rapid CSF reflux than a single hole pencil point spinal needle of the same gauge.

- Anesthetic solution distributes more evenly through the opposite holes of the Double-hole pencil point spinal needle compared to one sided orifice needles.

- Possibility to reduce the anesthetic solution given due to more even distribution, with less untoward side effects as compared to other spinal needles.

- 2 small symmetrical holes provide a significantly stronger tip than one sided hole.

- 5 fold increase in the immediate dispersal area compared to the Whitacre needle. It may reduce significantly the incidence of TNS (Transient Neurologic Symptoms) due to the local anesthetic maldistribution of the single hole pencil point spinal needles.

A: Yes. The maximum force needed to bend the Eldor spinal needle was 9.65 lbs. compared to the maximum force of 9.16 lbs. needed to bend the Gertie Marx needle.

A: Yes. The backflow of the cerebrospinal fluid could be seen in a mean time of 0.6 seconds in the Eldor spinal needle compared to 2.1 seconds in the 27G Pencan needle.

A: Yes. 26% of the patients of the Whitacre group and 14% of the patients of the Eldor group suffered from slight backache.

A: It is a 7 holes epidural catheter.

A: - The end hole can recognize an intravascular insertion of the epidural catheter tip, which a blunted tip cannot.

- The six lateral holes spaced circumferentially 1.5 cm or 2.4 cm from the tip allows anesthetic solution injection into the epidural space in cases where the end hole is obstructed by a blood clot or tissue.

- Six lateral holes provide better distribution of the anesthetic solution, avoiding a partial block.

A: Yes. The ELDOR Epidural Catheter (7-holed 20-gauge multiport catheter) has 3.5 times better sacral block (poor sacral block : 6% vs. 21%) than the 3-holed epidural catheters.

A: It is an 18G epidural needle with a 20G laser welded spinal conduit.

A: - The Eldor Needle is a specialized needle for combined spinal-epidural anesthesia.

- When used for epidural only, spinal conduit serves as a break against inadvertent epidural needle protrusion into spinal space .

- Epidural catheter can be inserted before the spinal anesthesia injection.

-Ability to do a test dose through the epidural catheter to check malposition before inserting the spinal dose through the spinal needle.

- Eliminates the danger of epidural catheter protrusion through the dural hole made by the spinal needle (different pathways for the epidural catheter and the spinal needle).

- Absence of metallic microparticles production while the spinal needle passes through the bent epidural needle tip, as in the needle through needle technique.

A: Eldor spinal needle technique

This is an innovative device in which there are two round
opposing holes at the tip. The anesthetic solution will flow
out of these two holes into the subarachnoid space at the
direction of these two holes. The Eldor spinal needle
separates dural fibers rather than cutting them to reduce
incidence of spinal headache. A small bore Eldor spinal
needle (26G) is inserted through an introducer until it
pierces the dura. Confirmation of its placement in the
subarachnoid space is when CSF is obtained through the hub
of the spinal needle. The local anesthetic solution is then
injected through the spinal needle into the subarachnoid
space. After the injection is completed the spinal needle is
withdrawn and the patient is positioned as required.

Local anesthetic injections

The local anesthetic solution injected into the subarachnoid
space is exited through the two opposing holes positioned
at the pencil point tip. The injection should be slow and
gentle. The dose should be adjusted to every patient and to
every operation. The orientation of the double holes is a
factor for the administration of the anesthetic solution.

Hazards

After confirmation of the Eldor spinal needle`s position in
the subarachnoid space, secure the needle during local
anesthetic solution injection from forward or backward
movements. Forward movement may cause paresthesias by the
pencil point`s tip touching a nerve root, while a backward
movement may withdraw the Eldor spinal needle or its
orifices from the subarachnoid space into the epidural
space, resulting in partial spinal anesthesia.
NOTE: The key on the spinal needle hub indicates the
direction of one of the distal spinal needle ports. The
second port parallels that on the side of the key.
Inject the desired dose of intrathecal medication at a rate,
level and direction consistent with the desired spread of
anesthesia or analgesia through both ports.
Follow national and/or institutional guidelines for patient
monitoring appropriate to the administration of spinal
anesthetics.

A: Eldor epidural catheter technique

Using the epidural needle the epidural space is reached by
the loss of resistance technique or the hanging drop
technique, while the proximal opening of the epidural needle
enters the epidural space. The epidural catheter is inserted
into the epidural space through the epidural needle. An
aspiration test and a test dose are done. If it is negative
the anesthetic solution is injected gradually until the
required dose-effect is achieved. The epidural needle is
withdrawn after the epidural catheter insertion or after the
epidural catheter aspiration test and test dose. The
epidural catheter length inside the epidural space should be
3 cm. This is measured in each patient according to the
markings in the epidural needle and the epidural catheter.
After withdrawing the epidural needle the epidural catheter
is secured on the patient`s back by a plaster to prevent
pull out and kinking. Withdrawal of the epidural catheter
after anesthesia, analgesia or several post-operative days,
should be done while the patient lies on his side with
flexed feet. The epidural catheter should be withdrawn
slowly and gently. Inspection of its completeness should be
done after its withdrawal.

Local anesthetic injections

Every time a local anesthetic solution is injected through
the Eldor epidural catheter it should be preceded by an
aspiration test and a test dose to avoid inadvertent
subarachnoid or intravascular injections of a large volume
of a local anesthetic solution into these spaces. After
performing the aspiration test and the test dose the
injections should be done gradually and slowly until
reaching the required anesthetic level.

Hazards

Do not withdraw an epidural catheter through an epidural
needle, because of danger of shearing the catheter.
After a positive aspiration test and/or test dose for
inadvertent subarachnoid placement - the epidural catheter
should be withdrawn or be treated as a spinal catheter.
After a positive aspiration test and/or test dose for
inadvertent intravascular placement - the epidural catheter
should be withdrawn, and no further injections be made
through it.
Do not insert the epidural catheter more than 3 cm inside
the epidural space, because of kink and/or malposition.
The epidural catheter does not always go at the intended
direction (cephalad or caudad).
The device is intended for short term use only, 72 hours or
less.

A: Combined Spinal-Epidural Anesthesia

Combined spinal-epidural anesthesia is a new kind of regional anesthesia that combines the spinal anesthesia with the epidural anesthesia. Both techniques are well known separately for their benefits and limitations. The combination of the spinal and the epidural routes as separate departments for local anesthetic injections gives a new kind of regional anesthesia. The benefits of the spinal anesthesia (rapid induction and excellent muscle relaxation) are combined with those of the epidural catheter (epidural catheter injections intraoperatively and epidural injections postoperatively).

Eldor Needle Technique

Using the Eldor needle the epidural space is reached by the loss of resistance technique or the hanging drop technique while the proximal opening of the epidural needle of the Eldor needle enters the epidural space. Then the epidural catheter is inserted into the epidural space through the epidural needle of the Eldor needle. A test dose is done as after any epidural catheter insertion. Then a small bore spinal needle (25G or less) is inserted through the spinal conduit of the Eldor needle until it pierces the dura. Confirmation of its placement in the subarachnoid space is when CSF is obtained through the distal orifice of the spinal needle. The local anesthetic is then injected through the spinal needle into the subarachnoid space. After the injection is completed the spinal needle is withdrawn. Then the Eldor needle is withdrawn leaving the epidural catheter in the epidural space. The catheter is attached to the back by plaster and the patient is turned on his back.

Local Anesthetic Injections

The dose of the local anesthetic injected into the subarachnoid space can be the same or lower than that injected when performing only spinal anesthesia. Local anesthetics can then be injected through the epidural catheter if the level achieved by the spinal injection is not enough for the operation, or when the spinal anesthesia wears off and the operation lasts more than the spinal anesthetic duration. Postoperatively, the epidural catheter serves for injecting opiates or local anesthetics as an excellent method of postoperative analgesia. The usual care of epidural opiates or local anesthetics injections should be practised.

Hazards

Intrathecal medications may obscure signs of epidural catheter malposition. The reduced ability to detect catheter malposition using an epidural test dose should be considered in the selection of this technique and in the choice of agents if the intrathecal medication is provided prior to the epidural dose.

A: Yes. At slow rates of injection, using 27- or 25-gauge sacrally directed Whitacre needles, injections showed evidence of maldistribution with extrapolated peak sacral lidocaine concentrations reaching 2.0%.

A: Yes. “The most likely explanation is maldistribution of the drug in the CSF causing high local concentrations around certain nerve roots.” (Gisvold SE. Editorial. Acta Anaesthesiol Scand 1999; 43: 369–370).

A: Yes. “The Eldor spinal needle showed a 5 fold increase in the immediate dispersal area compared to the Whitacre needle. The Eldor spinal needle showed greater immediate dispersal of injected solution despite being a smaller gauge. This advantage of the Eldor spinal needle over the Whitacre needle can improve anesthetic spread, provide optimal anesthesia and lessen the risk of local anesthetic toxicity.” (Charles H. Ripp).

A: Yes. In a meta-analysis of a total of 29 studies with a 2,813 patients ALMOST ALL THE CASES OF TNS (TRANSIENT NEUROLOGIC SYMPTOMS) WERE DONE BY THE WHITACRE, SPROTTE, PENCIL POINT, or the SMALL BORE QUINCKE. (Eberhart LH, Morin AM, Kranke P, Geldner G, Wulf H. Transient neurologic symptoms after spinal anesthesia. A quantitative systematic overview (meta-analysis) of randomized controlled studies. Anaesthesist 2002 Jul;51(7):539-46).

A: No.The epidural catheter is inserted through a different pathway than the spinal needle. The pencil point tip is retracting from the catheter even in the epidural space.

A: Yes. If you did not wear your glasses…

A: Yes. However, do not insert the spinal needle tip beyond the distal orifice of the spinal conduit.

A: Yes. Look at the relationships of the two hubs (Eldor spinal needle and Eldor combined spinal epidural needle) and you can know exactly where is the tip of the spinal needle at every moment of its insertion.

A: If you are in the right direction maybe the length of the hub of the Introducer shortens the length of the spinal needle. In that case, withdraw the Introducer and reinsert the spinal needle at the same path. As you know: "The distribution of distance from the skin to the epidural space in obstetric patients (n=2,123) was: < 3 cm - 0.3%; 3 to < 4 cm - 15%; 4 to < 5 cm - 47.3%; 5 to < 6 cm - 28.6%; 6 to < 7 cm - 6.9%; 7 to < 8 cm - 1.4%; and > 8 cm - 0.5%. "

A: None. The coiling of the epidural catheter is in direct function to the length it is inserted into the epidural space. The best length is 3 cm.

A: Yes. It is obvious.

A: Yes. If you don’t agree…start reading again.