International Journal of Colorectal Disease

, Volume 25, Issue 6, pp 775–781

High incidence of post-dural puncture headache in patients with spinal saddle block induced with Quincke needles for anorectal surgery: a randomised clinical trial

  • Marc D. Schmittner
  • Tom Terboven
  • Michael Dluzak
  • Andrea Janke
  • Marc E. Limmer
  • Christel Weiss
  • Dieter G. Bussen
  • Marc A. Burmeister
  • Grietje C. Beck
Original Article
  • 181 Downloads

Abstract

Purpose

Spinal saddle block represents nearly the ideal anaesthesia technique for anorectal surgery. Post-dural puncture headache (PDPH) is a dreaded complication but can be decreased by the use of non-cutting spinal needles to rates less than 1%. Though, cutting Quincke type needles are still widely used for economic reasons, leading to a higher rate of PDPH. We performed this study to demonstrate a reduction of PDPH by the use of very small 29-G compared with commonly used 25-G Quincke type spinal needles.

Methods

Two hundred sixteen adult patients (male/female, 19–83 years, ASA status I–III) were randomised 1:1 to groups, in which either a 25-G or a 29-G Quincke type spinal needle was used for a spinal saddle block. The incidence of PDPH was assessed during 1 week after surgery.

Results

Thirty-nine of 216 patients developed PDPH but there was no difference between the two needle sizes (25-G, n = 18/106 vs. 29-G, n = 21/110, p = 0.6870). Women suffered significantly more from PDPH than men (23/86 vs. 16/130, p = 0.0069). Ambulatory patients had a later onset of PDPH than in-patients (24 h [0.5–72] vs. 2 h [0.2–96], p = 0.0002) and the headache was more severe in these patients (NRS 7 [2–10] vs. NRS 3 [1–8], p = 0.0009).

Conclusions

The use of 29-G compared with 25-G Quincke needles led to no reduction of PDPH and is considerably higher compared with data from pencil-point needles. The use of non-cutting or pencil-point spinal needles should become the standard for performing spinal saddle block.

Keywords

Anorectal surgery Anaesthesia Saddle block Post-dural puncture headache 

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Marc D. Schmittner
    • 1
  • Tom Terboven
    • 1
  • Michael Dluzak
    • 1
  • Andrea Janke
    • 1
  • Marc E. Limmer
    • 1
  • Christel Weiss
    • 2
  • Dieter G. Bussen
    • 3
  • Marc A. Burmeister
    • 4
    • 6
  • Grietje C. Beck
    • 5
  1. 1.Department of Anaesthesiology and Surgical Intensive Care MedicineUniversity Medical Centre MannheimMannheimGermany
  2. 2.Department of Medical StatisticsUniversity Medical Centre MannheimMannheimGermany
  3. 3.Centre of Colo-ProctologyMannheimGermany
  4. 4.Department of AnaesthesiologyUniversity Medical Centre Hamburg-EppendorfHamburgGermany
  5. 5.Department of AnaesthesiologyDr. Horst Schmidt KlinikenWiesbadenGermany
  6. 6.B. BraunMelsungenGermany

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