Efficacy of different size Quincke spinal needles in reduction of incidence of Post-Dural Puncture Headache (PDPH) in Caesarean Section (CS). Randomized controlled study

Abstract

Background: Regional analgesia first introduced in clinical practice by the German surgeon Karl August Bier (1898). Spinal, epidural or combined spinal and epidural anaesthesia became the first line of choice in obstetric surgery. PDPH was found to be more frequent after Caesarean Section in young parturients. Also PDPH is related to CSF leakage from the subarachnoid space. Objectives: This prospective, double blinded, randomized study compares the frequency of PDPH following spinal anaesthesia for CS and technique difficulty with 22G, 25G and 29G Quincke needles. Methods: One hundred and eighty ASA I and II full term pregnant females aged 20-40 years, scheduled to receive spinal anaesthesia for elective CS, were randomly divided into three equal groups (n = 60 each). Each group received spinal anaesthesia with 22G (GI), 25G (GII) and 29G (GIII) Quincke needle. Difficulty in localizing the subarachnoid space and time taken to administer spinal anaesthesia were noted. Postoperatively; incidence, onset, site, duration and severity of headache were also studied. Results: PDPH occurred in 19 patients (31.7%) in GI, 7 patients (11.7%) in GII and 0 patients in GIII. However, the time taken to get CSF from onset of needle insertion was significantly different between the three groups; {13.6(5.2), 28.7(11.1) and 113.5(27.4) sec. mean(SD) in GI, GII and GIII} respectively. The duration of local anaesthetic injection through the spinal needles was significantly different between the three groups; {9.3(0.6), 15.3(1.2) and 37.4(1.7) sec. mean(SD); GI, GII and GIII} respectively. Also time to reach T4 block was significantly longer in GIII when compared with other groups; {5.7(0.8), 5.7(1.1) and 8.0(0.7) min. mean(SD); GI, GII and GIII} respectively. P < 0.05. Conclusion: Spinal anaesthesia with a 29G needle reduced the incidence of PDPH in elective CS to 0%. However, it is significantly more time consuming to give spinal anaesthesia with 29G needle than with the other needles.

A comparison of three different gauge Quincke’s spinal needles in patients undergoing elective surgery under spinal anaesthesia: a prospective randomized study

“…8,14 Time of appearance of CSF was significantly prolonged with 26 G Quincke spinal needle (14.60±2.56 sec) as compared to 4.14±1.81 seconds and 11.48±2.59 sec in group 1 and group 2 respectively. Similar observation was noted by Shah et al and Mohammed et al 6,10 CSF detection time directly depends on internal diameter of the needle. Smaller the internal diameter, greater is the time of detection.…”

“…6 Mean time of onset of SB was recorded and was observed highest in group 3 in our study. It was observed that needle with least internal diameter results in delayed onset of SB Similar findings was observed by Mohammed et al 10 This delay in the SB can be due to reason that fine gauge needle causes increased resistance which results in prolonged injection time of LA and hence delay in onset of block. Maximum height of SB achieved was noted and was observed that large number of patients achieved block till T8 in all the three groups.…”

“…Investigators believed that this could be due to delay in injecting LA through smaller gauge needle because of the increased resistance. 10 Statistically significant difference was observed in present study when authors compared time to achieve maximum degree of bromage between the groups. Increased duration was observed with 25 G and 26 G needles.…”

“…9 Mohammed et al reported 85% 1st attempt success with 25 G Quincke needle. 10 Oberhofer when examined 26-gauge spinal, recorded first attempt success rate of 72.9% and second attempt success rate as 20.3%. 5 Low success rate was due to enrollment of parturient in their study.…”

“…[6][7][8] Technical difficulty while using thinner needles further hampers the first attempt success rate and increases failure of block. 5,9,10 Considering how the needle gauge affects the performance of SA and how this can interfere with success of SA, authors compared the different gauge spinal needles i.e. 23, 25 and 26 G needles with regards to technical difficulty, success rate, quality of block and complications.…”