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PubMedDate not supplied

Comparison of Sprotte and Quincke needles with respect to post dural puncture headache and backache.

OBJECTIVE: The objective of this study was to compare 24-gauge Sprotte and 25-gauge Quincke needles with respect to post dural puncture headache and backache. METHODS: Three hundred ASA Physical Status I or II patients scheduled for minor orthopedic or urologic operations under spinal anesthesia were chosen for this randomized, prospective study at a university hospital and a city hospital. Anesthetic technique, intravenous fluids, and postoperative pain therapy were standardized. Patients were randomly divided into three equal groups. Spinal anesthesia was performed with either a 24-gauge Sprotte needle or a 25-gauge Quincke needle with the cutting bevel parallel or perpendicular to the dural fibers. RESULTS: Anesthesia could not be performed in three cases with the Sprotte needle and in one case with the Quincke needle. The most common complications were post dural puncture backache (18.0%), post dural puncture headache (8.2%), and non-postural headache (6.7%). No major complications occurred. The Quincke needle with bevel perpendicular to the dural fibers caused a 17.9% incidence of post dural puncture headache. The Quincke with bevel parallel to the dural fibers and the Sprotte needles caused similar post dural puncture headache rates (4.5% and 2.4%, respectively). Other factors associated with post dural puncture headache were young age, early ambulation, and sedation during spinal anesthesia. There were no significant differences between needles in the incidence of post dural puncture backache. CONCLUSION: Our data indicate that Quincke needles should not be used with the needle bevel inserted perpendicular to the dural fibers. The Sprotte needle does not solve the problem of post dural puncture headache and backache.

Adult↗
PubMed2006

Use of local anesthesia for arterial punctures.

BACKGROUND: Except for intravenous therapy, arterial access is the most common invasive procedure performed on critically ill patients. Arterial puncture is a source of pain and discomfort. Intradermal injection of lidocaine around the puncture site decreases the incidence and severity of localized pain when used before arterial puncture. OBJECTIVE: To review the recommendations and studies related to the use of intradermal lidocaine to decrease pain during arterial punctures. METHODS: Articles were identified by doing a systematic computerized search of MEDLINE (1980 to January 2006) to evaluate articles and reference lists of articles and a manual search of the references listed in original and review articles. English-language articles that evaluated any aspect of pain related to arterial puncture and cannulation, pain related to and methods of introducing lidocaine subcutaneously, and perceptions and use of local anesthesia for arterial or intravenous punctures were reviewed. RESULTS: Except among anesthesia providers, the use of a local anesthetic before arterial puncture is not universal, contrary to the standard of practice. A number of false perceptions may prevent wider use of such anesthetics. CONCLUSION: Before a plan for behavior modification or policy change is recommended for use of local anesthesia to decrease pain associated with arterial puncture, further research must be done to determine nurses' perceptions of use, actual practice, and currently established local policies.

Anesthetics, Local↗
PubMed1985

[Puncture technology and selective renal biopsy].

An experimental study of puncture technology for the kidney: We investigated the strength characteristics of tissues which are penetrated by the puncture needle for the kidney using a tension test. The tensile strength of the fascia, the muscle, the renal capsule, the renal parenchyma and the renal pelvis were 13.9, 1.1, 29.5, 0.5 and 21.4 kg/cm2, respectively. As the strengths differ, the needles for each tissue clearly need to be changed. Needle tip shape and needle material for kidney puncture were investigated by compression test, acryl resin injection into the renal vasculature, stereo-microscopy and scanning electron microscopy. These investigations revealed that the most suitable needle tip was a sharp cone shape, and material with a smooth surface and some flexibility such as Derlin seemed to be the most appropriate for the puncture needle for the kidney. Using the acryl resin injection method, stereo-microscopy and scanning electron microscopy, we studied the relative safety of single stage puncture and the repeated dilatation method to establish percutaneous nephrostomy. Single stage puncture seems to cause less damage to the kidney than the repeated dilatation method. Selective renal biopsy: A new puncture system using real-time ultrasound was developed at our clinic in 1978. The puncture procedure is monitored in 2 dimensional real-time images by a mechanical sector scanner equipped with an attachment for needle guidance. The application of the system to percutaneous renal biopsy is called "selective renal biopsy" because the specimen can be obtained selectively from any portion of the kidney.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2000

Light-guided tracheal puncture for percutaneous tracheostomy.

PURPOSE: To determine the effectiveness of lightwand-guided tracheal puncture for percutaneous tracheostomy. METHODS: The desired puncture site was marked on the skin of the anterior neck. A lightwand (Trachlight) was inserted into the patient's endotracheal tube (ETT), so that the number indicator on the lightwand matched the number indicator of the ETT of the patient. At this position, the light bulb of the lightwand was exactly placed at the tip of the endotracheal tube. With the lightwand turned on, the lightwand together with the endotracheal tube (ETT-LW) was slowly withdrawn from the trachea until a bright glow in the anterior neck could be seen 1 cm above the marked puncture site. At this position, the tip of the ETT was 1 cm above the puncture site. RESULTS: Percutaneous tracheostomy via a light-guided tracheal puncture was performed on 11 neurosurgical patients. The withdrawal of the endotracheal tube to a location above the puncture was accomplished easily with the lightwand. All percutaneous tracheostomies performed were successful, with ease and without any complications. The procedure time was 17.8 +/- 5.3 min. Mechanical ventilation was not interrupted during the whole procedure. CONCLUSION: The lightwand guided intratracheal puncture for percutaneous tracheostomy is a simple, effective, and safe procedure. This technique can avoid the risk of puncturing the endotracheal tube and/or cuff, thus allowing adequate ventilation and oxygenation during the percutaneous tracheostomy. Furthermore, this technique is inexpensive and minimizes the risk of damaging equipment like the fibreoptic bronchoscope.

Bronchoscopy↗
PubMed1998

Accidental dural puncture rates in UK obstetric practice.

Headache following epidural analgesia is a common cause of complaint, but accidental dural puncture rates vary among hospitals and with techniques. We were therefore interested to discover the extent of audit of dural puncture, the dural puncture rates in those UK centres that kept reliable records, and the techniques they used for detecting the epidural space. Consultants in charge of anaesthetic services to all 257 obstetric units in the UK were sent a questionnaire requesting numbers of obstetric epidurals, techniques used to detect the epidural space and the numbers of accidental dural punctures in the years 1991-1995. Replies were received from 191 respondents (74%) of whom 104 were able to provide some information about dural puncture rates. Dural puncture rate was inversely related to the number of epidurals performed; the highest recorded rate was 3.6% in a unit with < 300 epidurals annually, and the lowest 0.19% in a unit with > 1000. Most respondents did not record the loss of resistance technique used but among those who did, the dural puncture rate using mainly saline was 0.69% and using mainly air was 1.11% (P<0.001). Since accurate patient information is crucial for informed consent, audit needs to be improved in many centres. Though the accidental dural puncture rate may be under-reported in this survey, our data are in agreement with other findings that loss of resistance to saline is safer than loss of resistance to air.

Journal Article↗
PubMed1996

Assessment of the risk of glove puncture during oral surgery procedures.

PURPOSE: The purpose of this study was to examine the incidence of glove puncture during stages of oral surgery procedures. METHOD: One surgeon was requested to wear one type of sterile operating gloves during the treatment of patients who required an oral surgery procedure under outpatient local anesthesia. Each surgical procedure was divided into three modules, namely, (I) administration of the anesthesia and raising of mucoperiosteal flap, (II) bone removal and delivery of the tooth or root, and, (3) soft tissue repair. A total of 450 gloves worn during these modules were examined for punctures with a water inflation method and 200 unused gloves were tested as controls. RESULTS: The results were analyzed statistically with Fischer's exact test. A total of 12 punctures were recorded, indicating that a glove puncture occurred in 16% of the surgical procedures. Gloves from the left hand (the nonworking hand) in module III showed the highest incidence of punctures. One puncture was observed in the 200 gloves tested as controls. Statistical analysis indicated that glove puncture was significantly more likely to occur in gloves worn on the left (nonworking) hand overall as compared with gloves from the right hand (p = 0.02) and that glove puncture was significantly more likely to occur in gloves worn on the left hand in module III as compared with gloves from other modules (p = 0.01). Additional precautions may therefore be indicated during the soft tissue repair part of oral surgical procedures.

Data Interpretation, Statistical↗
PubMed1990

The incidence of undiagnosed punctures in non-sterile gloves.

This study investigates the incidence of undiagnosed punctures in five types of single and multiple patient use gloves worn by a group of practitioners (n = 6) in general and hospital practice, and provides data on the incidence of undiagnosed punctures in gloves worn on operative and passive hands. Gloves considered to be intact when discarded (n = 510, 85%) were examined for undiagnosed punctures by water inflation. The incidence of undiagnosed punctures varied considerably with glove type (range 3-49%) and among the practitioners (range 9-29%), and some gloves, notably the vinyl type investigated, appeared to be more prone to puncture than the other types of glove. More than 60% of the undiagnosed punctures were in the thumbs and second fingers of the gloves. The incidence of undiagnosed punctures in gloves from operative hands was only slightly greater than that for gloves from passive hands. The gloves intended for multiple patient use were found to have the lowest incidence of undiagnosed punctures. However, the single patient use gloves were typically misused, in that they were worn during the treatment of more than one patient.

Dentistry, Operative↗
PubMedDate not supplied

Unacceptable variability of hemoglobin estimation on samples obtained from ear punctures.

Sampling techniques were studied for the determination of the hemoglobin in volunteer blood donors. First, finger, ear, and venous samples were collected from 50 volunteers. Then five volunteers were monitored for a three-day period and finger, ear, and venous samples were collected daily. Thirdly, microhematocrits were done on the postdonation EDTA samples of 500 donors who had been screened using ear puncture copper sulfate hemoglobin estimations. Fourth, 25,437 donations were followed up to see whether capillary sampling techniques affected the rate of donor deferral. And finally, the ear sampling technique was varied using vigorous rubbing and manipulation to see if there was abnormal circulation that would affect the hematocrit results from capillary blood from the ear. We found that the microhematocrits averaged 7 per cent higher from blood obtained from ear puncture than from either finger puncture or venous puncture. Microhematocrits obtained from blood obtained by ear puncture were less accurate and less precise than blood from finger punctures. Finger puncture samples exclude approximately 6 per cent more donors than does blood from ear punctures.

Blood Specimen Collection↗
PubMed1997

[EMLA for anesthesia of puncture sites for large lumen indwelling venous catheters for autologous plasma and erythrocyte concentrate donation].

OBJECTIVE: The analgetic effect of EMLA-Creme (Lidocaine-Prilocaine-Cream) was studied in 52 patients undergoing preoperative autologous blood and/or plasma donation. METHOD: 95 venous punctures were performed with a 18 G or 16 G cannula. Puncture pain was estimated by the patients using a visual analog painscore (VAS 0-100). The data were evaluated regarding reaction time, puncture spot and cannula diameter. RESULTS: Within 15 minutes we find a clear reduction of puncture pain. The diameter of the cannula does not correlate with the painscore. Puncture of hand-back veins seems to be more painful than cubital vein puncture. CONCLUSION: The application of EMLA-Creme results in an effective analgesia for venous puncture. 37% of our patients were punctured without any pain and 67% felt a tolerable pain (VAS: 0-10).

Anesthetics, Local↗
PubMed2001

Effectiveness of epidural blood patch in the management of post-dural puncture headache.

BACKGROUND: Lumbar epidural blood patch (EBP) is a common treatment of post-dural puncture headache, but its effectiveness and mode of action remain a matter of debate. The aim of this study was to assess both the effectiveness and the predictive factors of failure of EBP on severe post-dural puncture headache. METHODS: This prospective observational study includes all patients treated in the authors' hospital with EBP for incapacitating post-dural puncture headache, from 1988 to 2000. The EBP effect was classified into complete relief (disappearance of all symptoms), incomplete relief of symptoms (clinically improved patients who recovered sufficiently to perform normal daily activity), and failure (persistence of severe symptoms). The following data were analyzed using a logistic regression to identify predictive factors of failure of EBP: (1) patient characteristics; (2) circumstances of dural puncture; (3) delay between dural puncture and EBP; and (4) the volume of blood injected for EBP. RESULTS: A total of 504 patients were analyzed. The frequency rates of complete relief, incomplete relief of symptoms, and failure after EBP were 75% (n = 377), 18% (n = 93), and 7% (n = 34), respectively. In a multivariate analysis, only the diameter of the needle used to perform dura mater puncture (odds ratio = 5.96; 95% confidence interval, 2.63-13.47; P < 0.001) and a delay in EBP less than 4 days (odds ratio = 2.63; 95% confidence interval, 1.06-6.51; P = 0.037) were independent significant risk factors for a failure of EBP. CONCLUSIONS: Epidural blood patch is an effective treatment of severe post-dural puncture headache. Its effectiveness is decreased if dura mater puncture is caused by a large bore needle.

Adult↗
PubMedDate not supplied

Pain degree and skin damage during arterio-venous fistula puncture.

The aims of this study were to evaluate the effect of needle bevel position on the degree of pain and damage to the skin covering the vein, in an arteriovenous fistula puncture, in haemodialysis patients. 48 patients with autologous arteriovenous fistula were studied. After puncture the patient was asked about the degree of pain perceived by means of an analogue visual scale and a descriptive verbal scale. When the needle was removed, the length of the cut made by the puncture was measured. The perceived pain assessed by analogue visual scale was greatest when the needle was punctured with the bevel facing upwards rather than downwards (median: 3 versus 2, p<0.003). The prick in the skin was greater when the puncture was made with the bevel facing upwards (19.7 +/- 5.6) rather than downwards (16.2 +/- 3.8, p<0.0001). It is concluded that arteriovenous fistula puncture with the bevel facing downward significantly reduces the degree of pain and the skin lesion at the point of puncture, without increasing the number of punctures.

Adolescent↗
PubMed2006

Influence of punctures, cuts, and surface morphologies of golden delicious apples on penetration and growth of Escherichia coli O157:H7.

The ability of Escherichia coli O157:H7 to penetrate and grow within punctures, fresh-cut surfaces, and calyces of Golden Delicious apples was investigated. A three-strain cocktail of E. coli O157:H7 resistant to ampicillin was used to inoculate fresh and 48-h-old punctures, fresh-cut surfaces, and open or closed calyces. A concentric cutting procedure was used to evaluate depth of penetration within punctures and prevent cross contamination during sampling. Within 2 h, E. coli O157:H7 penetrated vertically through the fresh punctures and 3.4 mm within the underlying parenchyma. After 48 h, E. coli O157: H7 cells penetrated up to 5.5 mm within the punctures and >2.6 mm horizontally away from fresh punctures. However, 48-h-old punctures did not permit penetration beyond their boundaries. Fresh-cut surfaces permitted up to 2.8 mm penetration after 24 h. Onset of growth of E. coli O157:H7 occurred 4 to 8 h postinoculation on fresh punctures and fresh-cut surfaces with populations increasing by 3 logs after 48 h. E. coli O157:H7 penetrated within calyces regardless of the extent of opening or method of inoculation. However, E. coli O157:H7 was never recovered from the inner core of apples. Computed tomography scan imaging revealed that closed calyces effectively prevented penetration of sodium iodide solutions within the calyx cavity. Lack of solution penetration may explain why sanitizing treatments are ineffective in inactivating microbial cells within the calyx. Understanding the role of morphological differences in permitting or restricting bacterial penetration may lead to development of more effective strategies to enhance the safety of fresh horticultural products.

Bacterial Adhesion↗
PubMed2002

A method for the determination of syringe needle punctures in rubber stoppers using stereoscopic light microscopy.

The ability to accurately determine the number of syringe needle penetration holes through the rubber stoppers in pharmaceutical vials and rubber septa in intravenous (i.v.) line and bag ports has been a critical factor in a number of forensic cases involving the thefts of controlled substances or suspected homicide by lethal injection. In the early 1990s, the microscopy and microanalysis group of the U.S. Food and Drug Administration's Forensic Chemistry Center (FCC) developed and implemented a method (unpublished) to locate needle punctures in rubber pharmaceutical vial stoppers. In 1996, as part of a multiple homicide investigation, the Indiana State Police Laboratory (ISPL) contacted the FCC for information on a method to identify and count syringe needle punctures through rubber stoppers in pharmaceutical vials. In a joint project and investigation using the FCC's needle hole location method and applying a method of puncture site mapping developed by the ISPL, a systematic method was developed to locate, identify, count, and map syringe punctures in rubber bottle stoppers or i.v. bag ports using microscopic analysis. The method requires documentation of punctures on both sides of the rubber stoppers and microscopic analysis of each suspect puncture site. The final result of an analysis using the method is a detailed diagram of puncture holes on both sides of a questioned stopper and a record of the minimum number of puncture holes through a stopper.

Cause of Death↗
PubMed1989

[Ultrasound-guided fine-needle puncture of the thyroid].

If properly performed, modern high-resolution real-time ultrasonography will disclose subtle differences in the texture of thyroid tissue and thereby enable the examiner to suggest a diagnosis. Nevertheless, there is often a need for a more specific diagnosis of solid or semisolid thyroid lesions - especially when the lesion might be malignant. Ultrasonically guided fine-needle aspiration biopsy (UG-FNB) allows a final cytological and/or histological diagnosis to be made in patients with benign or malignant space-occupying growths even if they are small. In its simplest form, thyroid nodules (diameter greater than 1.5 cm) with a uniform sonographic texture are punctured blind after determination of the site and size of the lesion on the basis of ultrasonic imaging. When the lesion is small and deeply situated (diameter less than or equal to 1.5 cm), this method will not be sufficiently accurate and more precise needle guidance is mandatory. In ultrasonically guided fine-needle puncture, the idea is to place the tip of an appropriate needle safely and accurately in the suspect lesion, so that representative specimens of solid tissue or fluid can be obtained and technical failures reduced. The main indication for biopsy of the thyroid gland is to differentiate between benign and malignant tumors. To compare the accuracy of conventional puncture techniques and ultrasonically guided puncture methods, 835 patients with benign or malignant space-occupying growth (even the small ones) were examined simultaneously with conventional and ultrasonically guided fine-needle aspiration biopsy over a period of 3 years (prospectively). Our results showed a significant difference in the sensitivity between conventional puncture without sonographic guidance and ultrasonically guided puncture techniques performed on patients with small and very small lesions (phi less than 2 cm). The size, macroscopic structure, and topographic-anatomical localization of the lesions were found to influence the diagnostic accuracy of the puncture techniques. UG-FNB is an excellent, effective, safe and painless method of treating uncomplicated thyroid cysts; it should be considered an alternative to surgery, if there are no clinical and cytological findings indicating malignancy and no severe space-occupying complications. Since the tip of the needle can be visualized on the scan, the needle may be advanced or withdrawn during aspiration so it is possible to empty the cyst completely. The use of ultrasound in the follow-up of patients with thyroid cyst puncture is mandatory to evaluate the results. Surgical therapy should be reserved for large cysts causing space-occupying complications.

Biopsy, Needle↗
PubMed2002

Epidural blood patching for preventing and treating post-dural puncture headache.

BACKGROUND: Dural puncture is a common procedure, but leakage of CSF from the resulting dural defect may cause postural headache after the procedure, and this can be disabling. Injecting an epidural blood patch around the site of the defect may stop this leakage, and so may have a role in preventing or treating post dural puncture headache. OBJECTIVES: To assess the possible benefits and harms of epidural blood patching in both the prevention and the treatment of post-dural puncture headache. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (Cochrane Library, Issue 4, 2000), MEDLINE (January 1994 to December 1998), and EMBASE (January 1980 to December 1998). We also searched the reference lists of relevant articles identified electronically, and asked both the authors of all included trials and colleagues with an interest in this area to let us know of any other potentially relevant studies not already identified. Date of last search: December 2000. SELECTION CRITERIA: We sought all properly randomised, unconfounded trials that compared epidural blood patch versus no epidural blood patch in the prevention or treatment of post-dural puncture headache among all types of patients undergoing dural puncture for any reason. The primary outcome of effectiveness was postural headache. DATA COLLECTION AND ANALYSIS: One reviewer extracted details of trial methodology and outcome data from the reports of all trials considered eligible for inclusion. We invited the authors of all such trials both to check the information extracted and to provide any details that were unavailable in the published reports. Intention-to-treat analyses were performed using the Peto O-E method. Information about adverse effects (post-dural puncture backache, epidural infection and lower limb paraesthesia) was also extracted. MAIN RESULTS: Three trials (77 patients) were eligible for inclusion. Methodological details were generally incomplete. Although the results of our analyses suggested that both prophylactic and therapeutic epidural blood patching may be of benefit, the very small numbers of patients and outcome events, as well as uncertainties about trial methodology, precluded reliable assessments of the potential benefits and harms of this intervention. REVIEWER'S CONCLUSIONS: Further, adequately powered, randomised trials (including at least a few hundred patients) are required before reliable conclusions can be drawn about the role of epidural blood patching in the prevention and treatment of post-dural puncture headache.

Blood Patch, Epidural↗
PubMed2005

Magnetic resonance image-guided trans-septal puncture in a swine heart.

PURPOSE: To test the feasibility of performing magnetic resonance (MR)-guided trans-septal punctures in the swine heart. MATERIALS AND METHODS: All procedures were performed in a 1.5-T MR scanner. A novel, active MR intravascular needle system was utilized for needle tracking and septal punctures. Trans-septal punctures were performed in five swine using electrocardiogram (ECG)-gated high resolution and non-ECG-gated, real-time MR imaging techniques. The intravascular needle was advanced over a guidewire from the femoral vein. Once the needle was in proper position, trans-septal punctures were made. RESULTS: Active tracking of the needle traversing the septum was possible. The location of the catheter tip was confirmed using real time gradient recalled echo (GRE). After a confirmatory ventriculogram with gadolinium-DTPA, a 0.014-inch guidewire was advanced into the left atrium and left ventricle. All punctures were made with no change in cardiac rhythm or rate; postmortem analysis was performed on all animals and demonstrated that 18/19 (95%) punctures were directly through the fossa ovalis. CONCLUSION: Using only MR guidance and a novel active intravascular needle system, we were able to repeatedly puncture the fossa ovalis in a swine heart from a transfemoral approach, with direct visualization of all components, including the needle, the atria, the fossa ovalis, and the surrounding vasculature.

Animals↗
PubMedDate not supplied

Puncture of stents implanted into veins and arteriovenous fistulas: an experimental study.

PURPOSE: Puncture of venous Wallstents and nitinol stents with dialysis needles was tested in an animal study. METHODS: In 15 sheep, divided into a group with prior surgical unilateral carotid-jugular shunt creation (9 sheep) and a second group without shunt creation (6 sheep), a self-expanding nitinol stent and/or a Wallstent were bilaterally placed into the jugular veins. After 1 month, 10 nitinol stents and 9 Wallstents were punctured weekly with a 15-gauge cannula over a period of 15 weeks. Stent patency was followed up by color-coded duplex ultrasound and angiography. After sacrifice, high resolution X-rays of the removed vessels were taken to assess stent deformation. From histological slices, neointimal thickness inside the stents was measured and analyzed statistically. RESULTS: Puncturing of both the nitinol stent and the Wallstent was technically feasible. Stent deformations were not found. One stent stenosis, probably related to puncture, was observed. The pattern of intimal hyperplasia differed between the nitinol stent and the Wall-stent. Outward bulge of the vascular layers over the stent struts was greater in nitinol stents. In the relevant area in between the stent struts there was no significant difference in intimal thickness between the two types of stents. Intimal thickness was more pronounced in shunted than in nonshunted animals only in the Wall-stent subgroup (p = 0.025) and more pronounced in punctured than in nonpunctured stents only in the nitinol stent subgroup (p = 0.018). CONCLUSION: Puncturing of stents was feasible without major short-term complications. Therefore, stent implantation into the punctured segment of a hemodialysis fistula may be indicated if there is no alternative treatment.

Alloys↗
PubMed2004

A new guidance device facilitates percutaneous puncture of the foramen ovale in human cadavers.

PURPOSE: Trigeminal neuralgia is the most common neurological cause for facial pain. Contemporary interventional treatment relies on surgical microvascular decompression or, alternatively, percutaneous interventions targeting the semilunar ganglion via the foramen ovale. For the latter approach, only free-hand punctures using fluoroscopy devices have been reported. Therefore, the present study aimed to evaluate a new fluoroscopy-based guidance device for transforaminal puncture. METHODS: Two experienced examiners punctured the foramen ovale bilaterally free-hand, and using a guidance device in human cadavers (n = 9). The number of attempts for puncture was recorded. A new attempt was counted each time the needle had to be retracted for redirection. RESULTS: As compared to the free-hand puncture of the foramen ovale (4.44 +/- 2.79), the new guidance device significantly reduced the number of trials needed (1.37 +/- 0.69). CONCLUSION: The employment of a guidance device facilitated percutaneous transforaminal puncture and resulted in a significantly decreased number of puncture attempts as compared to free-hand techniques in human cadavers.

Cadaver↗