Document Detail

Puncture technique and postural postdural puncture headache. A randomised, double-blind study comparing transverse and parallel puncture.
MedLine Citation:
PMID:  9834807     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: This clinical study was conducted in order to investigate the effect of two different orientations of the bevel during dural puncture on development of postural postdural puncture headache (PPDPH). METHODS: Two hundred and eighteen patients aged 18 to 50 years scheduled for minor non-obstetric surgery using spinal anaesthesia (SA) were included in this randomised, double-blind study. Dural puncture was performed using a 0.42 mm O.D. (27-g) Quincke spinal needle with the orientation of the bevel parallel or transverse relative to the longitudinal axis of the dural cylinder. All patients were blinded with regard to the puncture technique, and so was the anaesthesiologist performing a telephone interview 5 to 7 days postoperatively. The occurrence and duration of headache, backache and other complaints were recorded. Headache was classified as PPDPH or non-PPDPH, and intensity of the headache was registered using a numerical rating scale (NRS) from 0 to 10. RESULTS: Two hundred and twelve patients with a mean age of 35.3 years completed the study, 106 in each group. The two groups were comparable with regard to mean age, sex, local anaesthetics used and surgical procedure performed. Headache occurred in 44 patients postoperatively. PPDPH was diagnosed in 4/106 patients (3.8%) in the parallel group and 24/106 (22.6%) in the transverse group (P < 0.0002). Postoperative backache occurred in 31 and 20 patients (parallel compared to transverse) (NS). CONCLUSIONS: Dural puncture with the bevel of the needle transverse to the longitudinal axis of the dural cylinder gave significantly more cases of PPDPH than puncture with the bevel parallel to this axis even when using a 27-g Quincke needle. When using Quincke bevelled needles care must be taken to assure that the orientation of the bevel is parallel to the longitudinal axis of the dural sac.
H Flaatten; T Thorsen; B Askeland; M Finne; J Rosland; T Hansen; K Rønhovde; T Wisborg
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  42     ISSN:  0001-5172     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  1998 Nov 
Date Detail:
Created Date:  1999-02-16     Completed Date:  1999-02-16     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  DENMARK    
Other Details:
Languages:  eng     Pagination:  1209-14     Citation Subset:  IM    
Department of Anaesthesiology, Haukeland University Hospital, Norway.
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MeSH Terms
Anesthesia, Spinal / adverse effects,  instrumentation,  methods*
Back Pain / etiology
Double-Blind Method
Dura Mater
Follow-Up Studies
Headache / etiology*
Interviews as Topic
Middle Aged
Pain Measurement
Spinal Puncture / adverse effects,  instrumentation,  methods*
Time Factors
Comment In:
Acta Anaesthesiol Scand. 1999 Oct;43(9):967-8   [PMID:  10522747 ]

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

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