Recognition and differentiation of dural puncture click sensation: A subjective and objective prospective study of dural puncture forces using fine-gauge spinal needles

BACKGROUND: We hypothesized that the click perceived when puncturing the dura-arachnoid with fine-gauge spinal needles can be subjectively identified, and investigated whether it may be distinguishable among different needle types. METHODS: Subjective and objective evaluations were performed. First, physicians punctured the polyamide film or porcine dura mater (n = 70 and n = 20, respectively) with seven types of spinal needles and numerically evaluated the perceived click sensations. Using an 11-point numerical rating scale (from “0” for “no click sensation” to “10” for “the strongest click perceived”) data, subjective differentiation among needle types was assessed. Second, in the objective part of the study, total forces elicited by polyamide film or porcine dura mater punctures with each needle were measured using a biomechanical testing device, and load-displacement curves evaluated. Third, the results of subjective and objective evaluations were compared. RESULTS: All participants recognized the click and could discriminate among needles of different tip shape. The load-displacement curves for polyamide film and porcine dura mater were similar and needle-specific. The subjective numerical rating scale values corresponded well with the objectively measured changes in total forces (R(2) = 0.862 and R(2) = 0.881 for polyamide film and porcine dura mater, respectively), indicating that an increase in the largest drop in total force value of 0.30 N or 0.21 N would produce an increase of numerical rating scale value of 1 for polyamide film and porcine dura mater, respectively. CONCLUSIONS: We provide an objective proof of the click sensation felt upon dural puncture using different fine-gauge spinal needles. Click recognition could be used as an additional indicator of successful spinal puncture.