For those of you using Coude needles for SCS. what bevel orientation are you using as you are seeking a LOR? I just saw a video made by Gabor Racz. While not very clear, he seems to advocate having the bend of the needle and thus the needle bevel oriented downward and then turning the needle 180 degrees once entering the epidural space.
Coude Needles
- Thread starter NJPAIN
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I dont think it matters, I personally like the tip to be parralell to the cord, not perpendicular to it
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Coude?
For trials I just grab a 6" and start over L3. Angle of the dangle makes steering a breeze.
For trials I just grab a 6" and start over L3. Angle of the dangle makes steering a breeze.
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I advance the needle with tip bending downward, touch os, then turn 180 and enter epidural tip parallel and opening pointing upwards.
I don't use LOR here, get into epidural space with a guidewire, works much better than LOR in my opinion. So yes, it does matter to keep the tip parallel to the cord.
I don't use LOR here, get into epidural space with a guidewire, works much better than LOR in my opinion. So yes, it does matter to keep the tip parallel to the cord.
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I usually use a straight needle with a very shallow approach (short needle on thin, long needle on obese) and with that angle of approach, you're pretty darn close to parallel to the cord once you get there. I have used the curved, and they seem to work okay, but I think if you use a very shallow approach, so that you're not coming in at a very steep angle, it's less important what needle you use. Plus, with a curved stylet, you're going to come out of that needle tip in the direction of which way you have the lead tip rotated to, regardless of whether your needle tip is curved or straight. You can use that to your advantage, also. When it comes down to it, needle choice is operator dependent. Try different ones and use what you're most comfortable with. That's what's important.
I have been using and like starting two levels bellow and using a 6" needle in everyone. I think it makes a huge difference. I'm looking at coude for two reasons. One is to have as plan B for lumbar/thoracic use. Second, and more important, is for cervical SCS trials. I don't see much if any UE pain amenable to cervical SCS. However, now another group in town with a busy hand surgeon is planning to start to send these cases to me. I have consulted with docs who claim to do alot of cervical trials and most tell me they use a coude placed somewhere between T1 and T4.
