Unexpected retention of a spinal needle in a morbidly obese patient: a case report and technical reflection

Spinal anesthesia is considered a safe and effective anesthetic technique. However, some complications may be encountered in clinical settings such as needle fracture or retention, which is a rare but serious complication. Morbid obesity is a recognized risk factor for such technical difficulties due to increased tissue depth and altered anatomical landmarks. A 19-year-old male (BMI > 40) presented for elective umbilical hernia repair. Spinal anesthesia was attempted using a 25 G Vygon needle (120 mm). During the successful puncture, the patient suddenly hyperextended his back. On attempted needle withdrawal and redirection, only the introducer was retrieved; the spinal needle was retained subcutaneously. Surgical removal via a 10 mm incision at 6 cm depth was successful. Multiple factors contributed: morbid obesity, sudden patient movement, weak contact between introducer and needle, and potentially defective equipment. This case underscores the need for vigilance, appropriate equipment, and immediate multidisciplinary management.