[Perineal infiltration anaesthesia for episiotomy: a needle which is bent manually may break off and migrate through

R J Hop-de Groot1, J M J Sporken

  • 1Canisius-Wilhelmina Ziekenhuis, afd. Gynaecologie, Nijmegen. r.j.hopdegroot@gmail.com

A 28-year-old pregnant woman was given local anaesthesia in the perineum with a Monoject disposable needle in preparation for an episiotomy. The needle was bent manually in order to facilitate infiltration. During infiltration the needle broke off and disappeared. The delivery was uneventful. Radio diagnostic examination located the needle deep in the patient's left buttock. It was removed a week later via a small incision. Breakage of the needle was probably caused by the bending in combination with a sudden movement by the patient at the moment of infiltration. In obstetrics episiotomy is a common surgical procedure. For infiltration anaesthesia of the perineum a long, flexible, reusable Unimed needle is recommended instead of a short, inflexible, disposable Monoject needle.

Related Concept Videos

Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia01:30

Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia

Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...