• Sunena Somani, Pornpatra Areeruk, Louis Yue Hong Mok, Winnie Samy, Ranjith K Sivakumar, and Manoj K Karmakar.
• From the Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China (SS, PA, LY-H, WS, RK-S, MK-K).
• Eur J Anaesthesiol. 2021 Mar 1; 38 (3): 259-264.

BackgroundReal-time ultrasound-guided (USG) spinal injection is generally performed via the paramedian sagittal oblique (PMSO) ultrasound window.ObjectiveThe aim of this retrospective study was to draw attention to the occurrence of 'dry tap' during real-time USG spinal injection.DesignSingle-centre retrospective study.SettingUniversity teaching hospital, Hong Kong, China.PatientsData from 113 patients (aged 69.2 ± 18.0 years and BMI 22.3 ± 3.6 kg m-2) of American Society of Anesthesiologists physical status 1 to 3 scheduled for surgery under neuraxial blockade between 2007 to 2017 were reviewed.InterventionsReal-time USG spinal injections or combined spinal-epidural (CSE) using the PMSO ultrasound window with the patient in the lateral decubitus position and the spinal needle inserted from the nondependent side were studied.Main Outcome Measures'Dry tap' was defined as a failure of cerebrospinal fluid (CSF) to efflux from the hub of the needle, within 3 min, with the spinal needle visualised sonographically within the thecal sac. 'Slow CSF efflux' was defined as efflux of CSF within 1 to 3 min. Irrespective of whether it was a 'dry tap' or 'slow CSF efflux', the planned dose of local anaesthetic was injected through the spinal needle.ResultsThe combined incidence of 'dry tap' and 'slow CSF efflux' was 23.8% (27/113) with an individual incidence for each event of 9.7% (11/113) and 14.2% (16/113), respectively. Under the conditions of this study, successful spinal anaesthesia developed in all patients.Conclusion'Dry tap' occurs in 9.7% of cases during real-time USG spinal injection using the PMSO ultrasound window, with the patient in the lateral decubitus position and the spinal needle inserted from the nondependent side.Trial RegistrationChiCTR-IOR-1800019011, Chinese Clinical Trials Registry (www.chictr.org.cn).Copyright © 2020 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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