Document Detail


PDPH in obstetric anesthesia: comparison of 24-gauge Sprotte and 25-gauge Quincke needles and effect of subarachnoid administration of fentanyl.
MedLine Citation:
PMID:  8398955     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: Postdural puncture headache (PDPH) is a frequent complication of spinal anesthesia. Some investigators have recommended the use of the Sprotte needle to reduce the incidence of this serious complication. This study prospectively compared the incidence of PDPH with two spinal needles of different size and design: the 24-gauge Sprotte (noncutting point) versus the 25-gauge Quincke (diamond, cutting point). The hypothesis that subarachnoid fentanyl will reduce the incidence of PDPH, as suggested in the literature, was also studied. METHODS: Only patients for emergency or elective cesarean delivery were studied. One hundred ninety four patients were randomly assigned to receive spinal anesthesia with one of the two needles (Sprotte, n = 96; Quincke, n = 98). Simultaneously, each patient was assigned to receive hyperbaric 0.75% bupivacaine local anesthetic or a combination of the same concentration of local anesthetic with 20 micrograms of fentanyl (Sprotte with fentanyl, n = 47; Sprotte without fentanyl, n = 49; Quincke with fentanyl, n = 49; Quincke without fentanyl, n = 49). All patients were evaluated during the first 4 postoperative days, and follow-up telephone interviews were conducted 3 weeks after discharge. RESULTS: Four patients (4.2%) in the Sprotte group and seven (7.1%) in the Quincke group developed PDPH. Three out of four patients with headache in the Sprotte and four out of seven in the Quincke group received fentanyl as an adjunct for spinal anesthesia. Two patients in the Sprotte group required an epidural blood patch as a therapy for PDPH. Two patients in the Quincke group had severe headache and required an epidural blood patch. CONCLUSIONS: In the current study, the use of the 24-gauge Sprotte spinal needle resulted in a low incidence of severe PDPH, but was not significantly different when compared with the use of a 25-gauge Quincke needle (oriented parallel to the longitudinal dural fibers). The addition of fentanyl to hyperbaric bupivacaine spinal anesthesia did not reduce the risk of PDPH.
Authors:
A Devcic; J Sprung; S Patel; R Kettler; A Maitra-D'Cruze
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Regional anesthesia     Volume:  18     ISSN:  0146-521X     ISO Abbreviation:  Reg Anesth     Publication Date:    1993 Jul-Aug
Date Detail:
Created Date:  1993-11-04     Completed Date:  1993-11-04     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  7707549     Medline TA:  Reg Anesth     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  222-5     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Medical College of Wisconsin, St. Joseph's Hospital, Milwaukee 53226.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthesia, Obstetrical*
Anesthesia, Spinal*
Cesarean Section*
Double-Blind Method
Female
Fentanyl / administration & dosage,  therapeutic use*
Headache / epidemiology,  etiology*,  prevention & control
Humans
Incidence
Needles*
Pregnancy
Prospective Studies
Spinal Puncture / adverse effects*,  instrumentation
Subarachnoid Space
Chemical
Reg. No./Substance:
437-38-7/Fentanyl
Comments/Corrections
Comment In:
Reg Anesth. 1994 May-Jun;19(3):222   [PMID:  7999664 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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