eISSN: 1731-2515
ISSN: 0209-1712
Anestezjologia Intensywna Terapia
Bieżący numer Archiwum O czasopiśmie Rada naukowa Recenzenci Prenumerata Kontakt Zasady publikacji prac
Panel Redakcyjny
Zgłaszanie i recenzowanie prac online
2/2019
vol. 51
 
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Artykuł oryginalny

Impact of spinal needle design and approach to postdural puncture headache and spinal anesthesia failure in obstetrics

Roumiana Batova
1
,
Silvi Georgiev
1

  1. Department of Anesthesiology and Intensive Care, University Hospital of Obstetrics and Gynecology ‘Maichin Dom’, Medical University, Sofia, Bulgaria
Anestezjologia Intensywna Terapia 2019; 51, 2: 81–86
Data publikacji online: 2019/07/16
Pełna treść artykułu Pobierz cytowanie
 


Background
Concern has been raised that Sprotte needles predispose to spinal anes­thesia failure. Nevertheless, these needles are associated with a low incidence of postdural puncture headache. The impact of the paramedian approach to postdural puncture headache remains controversial. The objective of this prospective randomized study was to compare Sprotte, Quincke and Atraucan needles as well as the midline and the paramedian approach in terms of postdural puncture headache and spinal anesthesia failure in patients undergoing Caesarean section.

Methods
655 patients were randomized to 5 groups. A midline approach was used in four groups. The spinal needles were the 25G Sprotte, 27G Sprotte, 26G Atraucan and 25G Quincke. In the fifth group a 25G Quincke needle was used by the paramedian approach.

Results
The incidence of postdural puncture headache was 0% in both 25G and 27G Sprotte groups, 2.5% in the 26G Atraucan group, and 7.2% and 2.7% in the 25G Quincke midline and paramedian approach respectively. A significant difference in terms of postdural puncture headache was found between 25G Sprotte and 25G Quincke needles (P = 0.004), while the failure rate was similar between these two needles. A significant difference in spinal anesthesia failure rate was observed between midline and paramedian approaches (P = 0.041).

Conclusions
Sprotte but not Atraucan needle design correlates with lower incidence of postdural puncture headache compared to Quincke design. Sprotte needles are not associated with a higher spinal anesthesia failure compared to Quincke needles. The incidence of postdural puncture headache by the paramedian approach is not significantly reduced whereas the spinal anesthesia failure rate is increased in comparison to the midline approach.

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