Incidence Of Post-Dural Puncture Headache And The Use Of Different Types And Sizes Of Spinal Needles
Keywords:
headache, needles, subanachnoid anesthesia, spinal, surgeryAbstract
Introduction
Headache after spinal anesthesia is a relatively frequent complication, whose great variability in incidence is closely related to the caliber and design of the tip of the needles used.
Objective
To prospectively evaluate the incidence of headache after spinal anesthesia performed with different types and gauges of needles, in patients undergoing different types of surgical procedures.
Methods
Prospective, controlled, non-randomized clinical trial. 667 patients participated, divided into 2 groups, according to the subarachnoid puncture needle used, 29G needle (n=320) and 27G needle (n=347). Punctures were performed by anesthesiologists with more than 5 years of experience, through the median route. in the L2-L3, L3-L4, L4-L5 interspaces, with the aid of an introducer needle, with patients in a sitting position.
Results
There were 25 partial or total blockage failures, with no significant difference between the two needles studied. The total incidence of headache was 1.34% (9 cases): 2.56% with the 29G needle and 0.28% with the 27G needle. The degree of difficulty was significantly greater with the 29G needle, with the risk of impossibility of puncture being 19 times greater and the risk of headache occurring 9 times greater when using this needle. Epidural blood patching was performed in 4 cases of severe headache.
Conclusion
The results of this study demonstrated greater ease of puncture and a lower incidence of headache and failure to perform a puncture when using a 27G pencil point needle (Whitacre) compared to a 29G cutting needle (Quincke).
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