Abstract
This study was designed to compare the frequency of postdural puncture headaches (PDPH) using the 24 gauge Sprotte and the 27 gauge Quincke spinal needles in a population of patients less than 45 yr of age undergoing spinal anaesthesia for nonobstetrical surgery. Patients were randomly assigned to receive spinal anaesthesia with either the 24 gauge Sprotte spinal needle (n = 46) or the 27 gauge Quincke spinal needle (n = 47). Patients were interviewed on either postoperative day one or two and on postoperative day three. A PDPH was defined as a headache involving the occipital or frontal areas that is made worse when assuming either the sitting or standing position. Ninety-three patients were included in the analysis of data. The overall incidence of PDPH was 14% (13 of 93), and no difference was found between the Sprotte (15.2%) and Quincke (12.8%) needles. The distribution of the PDPHs by severity was not different between the two groups. None of the 13 patients with PDPHs required an epidural blood patch for relief of symptoms. Both the Sprotte needle and the Quincke needles were judged as easy to use and both required the same number of attempts in order to locate cerebrospinal fluid (first attempt successful: 73.9% versus 66%). Neither patient satisfaction nor the acceptability of spinal anaesthesia for a future procedure was adversely affected by the occurrence of a PDPH. The results of this study suggest that the risk of PDPH after spinal anaesthesia in young patients is similar using either the 24 gauge Sprotte or the 27 gauge Quincke spinal needle.
Résumé
Cette étude compare la fréquence de la céphalée postrachidienne (CPR) provoquée par l’aiguille 24G Sprotte et Quincke 27G dans une population de patients de moins de 45 ans soumis à une anesthèsie rachidienne pour chirurgie non obstétricale. Les patients sont répartis au hasard de façon à ce qu’on utilise soit l’aiguille rachidienne 24G Sprotte (n = 46), soit l’aiguille rachidienne 27G Quincke (n = 47). On interroge les patients le premier ou le deuxième jour après l’opération, et le troisième jour. Une CPR est définie comme une céphalée occipitale ou frontale aggravée par le position assise ou debout. Les données de 93 patients sont analysées. L’incidence totale des CPR est de 14% (13 de 93) et on ne trouve pas de différence entre l’aiguille Sprotte (15,2%) et l’aiguille Quincke (12,8%). La sévérité de la CPR n’est pas différente entre les deux groupes. Dans aucun des 13 cas de CPR, il n’est nécessaire de colmater avec du sang autologue. On juge les aiguilles Sprotte et Quincke faciles à utiliser et un nombre identique d’essais est requis pour ponctionner la dure-mère (succès au premier essai 73,9% vs 66%). Le degré de satisfaction et d’acceptabilité n’ont pas été affectés par l’apparition de CPR. Les résultats de cette étude suggèrent que le risque de CPR après anesthèsie rachidienne chez des jeunes patients est identique avec les deux auguilles rachidiennes utilisées, la Sprotte 24G et la Quincke 27G.
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References
Flanagan JF, Kumatta D, Black D. Comparison of 24 gauge Sprotte and 27 gauge Quincke needle on the incidence of post durai puncture headache. Anesth Analg 1991; 72: S75.
Kang SB, Goodnough DE, Lee YK, et al. Comparison of 26- and 27-G needles for spinal anesthesia for ambulatory surgery patients. Anesthesiology 1992; 76: 734–8.
Hurley RJ, Hertwig LM, Lambert DH. Incidence of post durai puncture headache in the obstetrical patient: 25 gauge Whitacre vs 26 and 27 gauge Quincke tip needles. Reg Anesth 1992; 17: S33.
Mayer DC, Quance D, Weeks SK. Headache after spinal anesthesia for Cesarean section: a comparion of the 27-gauge Quincke and 24-gauge Sprotte needles. Anesth Analg 1992; 75: 377–80.
Coté S, Socci M, Wiesel S. Spinal anaesthesia with the 27 gauge needle. Can J Anaesth 1991; 38: A46.
Sprotte G, Schedel R, Pajunk H. Eine“atraumatische” Universalkanule fur einzeitige Regionalanaesthesien. Reg Anaesth 1987; 10: 104–8.
Tarkkila PJ, Heine H, Tervo R-R. Comparison of Sprotte and Quincke needles with respect to post durai puncture headache and backache. Reg Anesth 1992; 17: 283–7.
Büttner J, Wresch KP, Klose R. Bietet eine konisch geformte Kanülenspitze Vorteile bei der Spinalanaesthesie? Reg Anaesth 1990; 13: 124–8.
Dixon CL. The Sprotte, Whitacre, and Quincke spinal needles. Anesthesiology Review 1991; 18: 42–7.
Crone L-AL, Vogel W. Failed spinal anesthesia with the Sprotte needle (Letter). Anesthesiology 1991; 75: 717–8.
Büttner J, Wresch KP, Klose R. Fewer failed spinal anesthestics with the Sprotte needle (Letter). Anesthesiology 1992; 77: 393.
Vandam LD, Dripps RD. Long-term follow-up of patients who received 10,098 spinal anaesthetics. JAMA 1956; 161: 586–91.
Flaatten H, Rodt S, Rosland J, Vamnes J. Postoperative headache in young patients after spinal anaesthesia. Anaesthesia 1987; 42: 202–5.
Lybecker H, Mϕller JT, May O, Nielsen HK. Incidence and prediction of postdural puncture headache. A prospective study of 1021 spinal anesthetics. Anesth Analg 1990; 70: 389–94.
Sarma VJ, Boström U. Intrathecal anaesthesia for day-care surgery. A retrospective study of 160 cases using 25- and 26-gauge spinal needles. Anaesthesia 1990; 45: 769–71.
Driessen A, Mauer W, Fricke M, Kossmann B, Schleinzer W. Prospective studies on the pathologic mechanism of post-spinal headache in a select group of patients. Anaesthetist 1980; 29: 38–41.
Crawford JS. Experience with spinal analgesia in a British obstetric unit. Br J Anaesth 1979; 51: 531–5.
Flaatten H, Raeder J. Spinal anaesthesia for outpatient surgery. Anaesthesia 1985; 40: 1108–11.
Barker P. Are obstetric spinal headaches avoidable? Anaesth Intensive Care 1990; 18: 553–4.
Guerts JW, Haanschoten MC, van Wijk RM, Kraak H, Besse TC. Post-dural puncture headache in young patients. A comparitive study between the use of 0.52 mm (25-gauge) and 0.33 mm (29-gauge) spinal needles. Acta Anaesthesiol Scand 1990; 34: 350–3.
Rasmussen BS, Blom L, Hansen P, Mikkelsen SS. Postspinal headache in young and elderly patients. Two randomised, double-blind studies that compare 20-and 25-gauge needles. Anaesthesia 1989; 44: 571–3.
Cesarini M, Torrielli R, Lahaye F, Mene JM, Cabiro C. Sprotte needle for intrathecal anaesthesia for Caesarean section: incidence of postdural puncture headache. Anaesthesia 1990; 45: 656–8.
Abboud TK, Zhu J, Reyes A, et al. Effect of subarachnoid morphine on the incidence of spinal headache. Reg Anesth 1992; 17: 34–6.
Dittmann M, Renkl F. Spinal anesthesia with extremely fine needles (Letter). Anesthesiology 1989; 70: 1035–6.
Flaatten H, Rodt SA, Vamnes J, Rosland J, Wisborg T, Koller ME. Postdural puncture headache: a comparison between 26- and 29-gauge needles in young patients. Anaesthesia 1989; 44: 147–9.
Naulty JS, Hertwig L, Hunt CO, Datta S, Ostheimer GW, Weiss JB. Influence of local anesthetic solution on postdural puncture headache. Anesthesiology 1990; 72: 450–4.
Quaynor H, Corbey M, Berg P. Spinal anaesthesia in daycare surgery with a 26-gauge needle. Br J Anaesth 1990; 65: 766–9.
Dahl JB, Schultz P, Anker-Mϕller E, Christensen EF, Staunstrup HG, Carlsson P. Spinal anaesthesia in young patients using a 29-gauge needle: technical considerations and an evaluation of postoperative complaints compared with general anaesthesia. Br J Anaesth 1990; 64: 178–82.
Lynch J, Arhelger S, Krings-Ernst I. Post-dural puncture headache in young orthopaedic in-patients: comparison of a 0.33 mm (29-gauge) Quincke-type with a 0.7 mm (22-gauge) Whitacre spinal needle in 200 patients. Acta Anaesthesiol Scand 1992; 36: 58–61.
Mihic DN. Postspinal headache and relationship of needle bevel to longitudinal durai fibers. Reg Anesth 1985; 10: 76–81.
Johnson MD, Hertwig L, Vehring PH. Datta S. Intrathecal fentanyl may reduce the incidence of spinal headache. Anesthesiology 1989; 71: A911.
Kaplan G. The psychogenic etiology of headache post lumbar puncture. Psychosom Med 1967; 29: 376–9.
Daniels AM, Sallie R. Headache, lumbar puncture, and expectation (Letter). Lancet 1981; 1: 1003.
Gielen M. Post durai puncture headache (PDPH): a review. Reg Anesth 1989; 14: 101–6.
Lambert DH. Complications of spinal anesthesia. Int Anesthesiol Clin 1989; 27: 51–5.
Gerard KW, Fagraeus L. Postspinal headache. Seminars in Anesthesia 1990; 9: 69–74.
Weeks SK. Spinal headache — prevention and treatment. Can J Anaesth 1990; 37: S53–8.
Cambell DC. Douglas MJ, Pavy TJC, Flanagan ML, McMorland GH. Comparison of 25G Whitacre vs 24G Sprotte needles for Caesarean section. Can J Anaesth 1992; 39: A46.
Devcic A, Sprung J, Maitra-D’Cruze A, Haddox JD. Post-dural puncture headache in an obstetric population: comparison of 24-ga Sprotte and 25-ga Quincke needles. Reg Anesth 1992; 17: S69.
Ross BK, Chadwick HS, Mancuso JJ, Benedetti C. Sprotte needle for obstetric anesthesia: decreased incidence of post durai puncture headache. Reg Anesth 1992; 17: 29–33.
Schneider M, Schuhmacher P, Kaufmann M. Incidence of postdural puncture headache (PDPH) in young pregnant and nonpregnant women after spinal anesthesia with a 24G Sprotte needle. Reg Anesth 1992; 17: S93.
Norris MC, Leighton BL, DeSimone CA. Needle bevel direction and headache after inadvertant dural puncture. Anesthesiology 1989; 70: 729–31.
Ready LB, Cuplin S, Haschke RH, Nessly M. Spinal needle determinants of rate of transdermal fluid leak. Anesth Analg 1989; 69: 457–60.
Fennelly M, Galletly DC, Purdie GI. Is caffeine withdrawal the mechanism of postoperative headache? Anesth Analg 1991; 72: 449–53.
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Wiesel, S., Tessler, M.J. & Easdown, L.J. Postdural puncture headache: a randomized prospective comparison of the 24 gauge Sprotte and the 27 gauge Quincke needles in young patients. Can J Anaesth 40, 607–611 (1993). https://doi.org/10.1007/BF03009696
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DOI: https://doi.org/10.1007/BF03009696