24 g Sprotte and 27 g Quincke Needle

8/10/2019 24 g Sprotte and 27 g Quincke Needle

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607

S a u l W i e s e l M O M Sc F R C PC , M i c h a e l J . T e s s l e r M D F RC P C,

L . J a n e E a s d o w n M D F RC PC

Postdural puncture

headache: a random ized

prospect ive comparison

of the 4 gaug e Sprot te

and the 7 gau ge

Q uincke needles in

young pat ients

This s tudy was des igned to compare the f requen cy o f pos tdura l

punc tur e headaches (PD PH ) us ing the 24 gauge Spro t te and

the 27 gauge Quincke sp ina l need les in a popu la t ion o f pa t ien t s

less than 45 yr o f age undergoing spin al anaesthesia fo r non-

obstetrical surgery. Patients were randomly assigned to receive

spinal anaesthesia with ei ther the 24 gauge Sprotte spinal needle

(n = 46) or the 27 gauge Quincke spinal needle (n = 47).

Patients were interviewed on ei ther postoperative day one or

two an d on pos topera t ive day three. A P D P H was de f ined

as a headache involving the occipi tal o r fro nta l areas that is

made worse when assuming e i ther the s i t t ing or s tand ing po-

si t ion. Ninety- thr ee patien ts were included in the analysis o f

data. The overall incidence o f P D P H was 14 (13 o f 93) , an d

no d i ff erence was fo un d be tween the Spro t te (15 .2 ) and

Quincke (12 .8 ) need les . The d i s tr ibu t ion o f the PD PH s by

severi ty was not dif ferent be tween the tw o groups. No ne o f

the 13 pa t ien t s w i th P DP Hs requ ired an ep idura l b lood pa tch

for re l i e f o f symptom s . Bo th the Spro t te need le an d the Q uincke

needles were jud ged as easy to use and both required the sam e

nu mb er o f at tempts in order to locate cerebrospinal f lu id ( f irst

atte mp t successful: 73.9 versus 66 ). Neit her pa tie nt satis-

ey words

ANAESTHETIC T E C H N I Q U E S: s p i n a l ;

COMPL ICAT IONS: hea da ch e .

F r o m t h e D e p a r t m e n t s o f A n a e s t h e si a , S i r M o r t i m e r B .

Dav is - Jewish Genera l Hosp i ta l and McGi l l Un ive rs i ty ,

M o n t r e a l , C a n a d a .

P r e s e n te d i n p a r t a t t h e 4 9 th A n n u a l M e e t i n g o f t h e

Ca nad ia n A naes the t i s t s Soc ie ty , June 1992 , T oron to , Canad a .

Address correspondence to: Dr. Saul Wiesel , University of

New M exico Schoo l o f Med ic ine , D ep t . o f Anes thes io logy and

Cr i t ica l Ca re Med ic ine , S u rge Bu i ld ing , Albuqu erque , New

Mexico , USA 87131-5216 .

Accep ted or pub l ica t ion 29 th March, 1993.

fact io n no r the acceptabili ty o f spina l anaesthesia for a fut ur e

procedure was adversely af fected by the occurrence o f a PD PH.

The resu l ts o f th i s s tudy suggest tha t the r i sk o f P D P H a f ter

spinal anaesthesia in young patients is s imilar using ei ther the

24 gauge Sprone or the 27 gauge Quincke sp ina l needle.

Cette dtude comp are la frOquence de la c~pha l~e post-

rachidienne (CP R) provoqu~ e pa r l 'aiguil le 24G Sprotte et

Quincke 27G dans u ne popu la t ion de pa t ien t s de moins de

45 arts sou mis ?l une anesthdsie rachidienne po ur chirurgie n on

obst~tricale. Les patie nts so nt rOpartis au hasard de far

ce qu' on utilise soit l 'aiguille rachidienne 2 4G Spro tte (n =

46), soi t l 'aiguil le rachidienne 27G Quincke (n = 47). On in-

terroge les patien ts le prem ier ou le deuxi~m e jo ur apr~s l'o-

p~ration, et le troisi~me jour. Une C PR est d~finie com me une

c~phalOe occipi tale ou front ale aggrav~e par le posi t ion assise

ou debout . Les don nOes de 93 patien ts sont analysdes. L 'in-

cidence totale des CPR est de 14 (13 de 93) et on ne trouve

pa s de difference e ntre I'aiguille Spro tte (15,2 ) et l 'aiguille

Qu incke (12 ,8 ) . La s~vkri tO de la CP R n'est pas di ff~rente

en t re l e s deux groupes . Dans aucun des 13 cas de CPR, i l

n 'est n~cessaire de colm ater avec du sang autologu e. On jug e

les aiguil les Spro tte et Quin cke faci les ~ ut i l iser et un nom bre

identique d 'essais est requis po ur po nction ner la dure-mbre

(succ~s au pre mi er essai 73,9 vs 66 ). Le degr~ de satisfaction

et d 'acceptabili t~ nb nt pas dt~ af fect~s pa r l 'appari t ion de CPR .

Les r~sultats de cet te ~tude suggbrent que le r isque de CP R

aprbs anesthdsie rachidienne chez d es jeu nes patien ts est iden-

tique avec les deux auguilles rachidiennes utilis~es, la Sprotte

24G e t la Quincke 27G.

P o s t d u r a l p u n c t u r e h e a d a c h e ( P D P H ) t h a t c a n f ol lo w

s p i n a l a n a e s t h e s i a m a y l i m i t th e a p p l i c a t i o n o f t h i s a n -

a e s t h e t i c t e c h n i q u e . I t m a y l e a d t o p a t i e n t d i s t r e s s , p r o -

l o n g e d h o s p i t a l i z a t i o n a n d r e q u i r e a n e p i d u r a l b l o o d

CAN J ANAESTH 1993 / 40:7 / pp607-11


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6 8 CANADIAN JOURNAL OF ANAESTHESIA

pa tch fo r re so lu t ion . In o rde r to dec rease the ra te o f

P DP H, the sm a l le s t gauge Quincke need le ava i l ab le i s

u s ed . T h e r e p o r t e d P D P H r a te s fo r th e 2 7 g au g e Q u i n c k e

need le range f rom 1 .5% to 3 . 7% I-4 and m ay even be

as high as 10.45%. 5 W hile early s tudies us in g the n on -

cu t t ing S pro t t e need le sugges ted a P DP H as low as

0 . 02%, 6 o the r s tud ies in non-obs te t r i ca l pa t i en ts do no t

a p p e a r t o s u p p o r t t h e s e f i g u r e s a n d s u g g e s t a P D P H

ra te o f approx im a te ly 2 . 4% 7 and even a s h igh a s 8 . 2%. 8

F ur the rm o re , the h ighe r cos t o f the S pro t t e need le 9 a s

well as the controve rs ia l issue o f fa iled anaes the s ia despi te

adequa te re tu rn o f ce rebrosp ina l f lu id ~0.1 m ay nega te any

a d v a n ta g e s in r e d u c in g t h e r a t e o f P D P H .

Y o u n g e r p a t ie n t s a p p e a r t o b e a t h i g h e r r is k o f P D P H

than do o lde r p a t i en ts 2 :2 -1s and would bene f i t g rea t ly

f r o m a r e d u c t i o n i n t h e r a t e o f P D P H . T h e r e f o r e , w e

c o m p a r e d t h e i n ci d en c e o f P D P H a f t er u se o f t h e 2 4

gauge S pro t t e and the 27 gauge Quincke need les fo r sp i -

na l anaes thes ia in a popula t ion o f young pa t i en t s un-

de rgo ing sp ina l anaes thes ia fo r non-obs te t r i ca l su rge ry in

a random ized , p rospec t ive m anner .

e t h o d s

Approva l o f the hosp it a l E th ic s and R esea rch Com m it tee

and wr i t t en in form ed consen t were ob ta ined f rom pa -

t ien ts . A s p a r t o f ob ta in ing in form ed co nsen t fo r sp ina l

anaes thes ia , pa t i en t s were in form ed tha t the re was a p os -

s ib i l i ty tha t they would have a headache a f t e r the an-

aes the t i c , bu t de ta i l s conce rn ing i t s cha rac te r were no t

given. This prospect ive s tudy involved 96 pat ients less

than 45 yr o f age undergo ing e lec t ive o r em ergency

surgery. Obstetr ical pat ients were excluded. Pat ients were

random ized to rece ive sp ina l anaes thes ia wi th e i the r the

24 gauge S pro t t e need le (8 . 89 cm ; P a junk , Germ any)

or the 27-gauge Quincke need le (8 . 89 cm ; Bec ton Dick-

inson , F rank l in Lake , New Je rsey) . The fo l lowing da ta

were recorded: pat ient age, sex, ASA class if icat ion, e lec-

t iv e o r e m e r g e n c y n a t u r e o f t h e s u r g e ry , n u m b e r o f a t -

t em pts a t dura l punc ture , pos i t ion dur ing induc t ion of

spinal anaes thes ia (s i t t ing or la tera l) , type of anaes thet ic

agen t ( l idoca ine o r bup ivaca ine ) and i t s ba r ic i ty (hyper -

ba r ic o r i soba r ic ) and the add i t ion o f ep inephr ine o r any

narcot ic (fentanyl or sufentani l ) to the anaes thet ic solu-

t ion . The anaes the t i s t ra ted the use o f the s tudy need le

as easy, mo derate ly diff icul t or diff icult . Th e Q uinck e nee-

dle was introduced with the bevel paral le l to the sagi t ta l

p lane . Wi th e i the r need le , the m id l ine approa ch to lum bar

punc ture was used .

P a t i en t s were in te rv iewed in pe rson or by t e lephone

( i f d i s cha rged f rom the hosp i t a l ) by an anaes the t is t no t

invo lved wi th the case o r by a re sea rch nurse . Bo th were

b l inded to the sp ina l need le used . In te rv iews took p lace

on e i the r pos tope ra t ive days one o r two and on pos t -

TABLE I Patientdemographics

Sprotte uincke

n 46 47

Me an age (SD ) 32.4 (7.3) 34.2 (8.0)

Male/Female 27/19 23/24

Elective (%) 41 (81.9) 41 (87.2)

ASA 1,11,III 41,5,0 41,4,2

TAB LE 11 Intraop erative ariables

Sprotte uincke

n 46 47

Sitting position %) 45 (97.8) 43 (91.5)

Lidocaine (%) 37 (80.4) 37 (78.7)

Bupivacaine %) 9 (19.6) l0 (21.3)

Hyperbaric %) 41 (89.1) 39 (83)

Isobaric (%) 5 (10.9) 8 (17)

Epinephrine added (%) l (2.2) 2 (4.3)

Narco tic added (%) 21 (45.7) 12 (25.5)

Num ber of attempts:

- One (%) 34 (73.9) 31 (66)

- Two (%) I I (23.9) 14 (29.8)

- Thr ee or more (%) 1 (2.2) 2 (4.3)

Difficulty % "Easy") 89.1 95.7

opera t ive day th ree . A headac he was de f ined a s a P D P H

if i t fulfdled the fol lowing two cri teria : locat ion in the

occ ip i t a l and /or f ron ta l a reas o f the head wi th exace r -

bat ion of sym ptom s wh en s i t t ing or s tanding . ~6 Severi ty

o f s y m p t o m s o f P D P H w e r e r a te d b y t h e p a t ie n t s a s

m i ld , m odera te o r s eve re . F ur the rm ore , on pos tope ra -

t ive day three the pat ients were asked the fol lowing two

quest ions : Were you sat is f ied with the anaes thet ic

you rece ived? Would you wish to rece ive the s am e type

of anaes the t i c in the fu tu re fo r a s im i la r su rg ica l p roce -

dure?

Stat is t ical analys is was performed us ing the Chi-square

tes t with Yates' correct io n, with P < 0.05 considere d s ta-

tistically significant.

R e s u l t s

Ini t ia l ly, 96 pat ients were included in the s tudy. None

was exc luded because o f fa i lu re to ob ta in ce rebrosp ina l

f lu id . In te rv iews cou ld no t be com ple ted in th ree , l eav ing

93 fo r ana lys is (S pro t t e g roup , n = 46 , Quincke grou p ,

n = 47) with a 96.9% fol low-up ra te . Pat ien t groups did

no t d i f fe r dem ographica l ly (Tab le I ) . Th e tw o groups had

s im i lar anaes the t ic d rugs and pos i t ion ing (Tab le I I ). B oth

sp ina l need les were judged to b e s im i la r in ease o f use

i n t e r m s o f t h e n u m b e r o f a t t e m p t s r e q u i r e d t o o b t a i n

C S F and the d i f f icu l ty ra t ing g iven by the anaes the t i s t

(Tab le I I ) . No sp ina l anaes the t i c requ i red convers ion to

a general anaes thet ic .


3/5

W i e s e l

e t a l :

P D P H : S P R O T T E 2 4 V S Q U I N C K E 2 7 6 0 9

T A BL E I I I P a t i e n t s a t i s fa c t i on / a c c e p t anc e a nd sp i na l ne e d l e

S p r o t t e Q u i n c k e

n 46 46

Sat isf ied wi th present anaesthe t ic :

- (% ~Yes ) 44 (95.7) 42 (91.3)

Would accept s imi la r anaesthe t ic aga in:

- (% Yes ) 41 (89.1) 41 (89.1)

T A B L E I V P a t i e n t s a t i s fa c t i on / a c c e p t anc e a nd P D P H

P D P H p r es e nt P D P H a b se n t

n 13 79

Sat isf ied wi th present anaesthe t ic :

- (% Yes ) 11 (84.6) 75 (94.9)

Woul d a c c e p t s i mi l a r a na e s t he t ic a ga i n :

- (% Yes ) II (84.6) 71 (89.9)

Th e ove ra l l inc idence o f P D P H w as 14 (13 pa t i en ts

of 93). In the S pro t t e g roup , s even pa ti en t s had po s tdura l

punc ture headac he (15 .2 ) , com pa red wi th s ix pa t i en ts

in the Quineke group (12 .8 , NS ) . The s eve r i ty o f

P D P H s was s im i la r in each group: two pa t i en ts desc ribed

m i ld , one m odera te and th ree s eve re sym ptom s . One pa -

t i en t in the S pro t t e g roup co u ld no t ra te the s eve r ity o f

the d i s com for t . Non e of the 13 pa t i en ts wi th P D P H re -

qu i red an ep idura l b lood pa tch to re li eve sym ptom s .

Pat ient sa t is fact ion with the spinal anaes thet ic was

equa l ly h igh in bo th g roups , a s was the accep tance o f

a s im i la r anaes the t i c in the f u tu re (Tab le I I I ) . These d id

no t dec rease in those pa t i en t s who deve loped a P DP H

(Table IV) . On e pa t i en t cou ld no t dec ide whe the r he was

sat is f ied with the anaes thet ic or would accept a s imilar

one in the fu tu re .

i s cus s ion

T h e i n c i d e n c e o f P D P H i n t h e p r e s e n t s t u d y w i t h t h e

27 gauge Quincke need le was 12 .8 and i s som ewha t

high er than the values , betwe en 1.5 and 3.7 , that oth-

e rs have repor ted . ,-4 P rev ious ly , we repor ted a P D P H

rate of 19.6 in pat ients less than 40 yr of age us ing

t h e 2 7 g a u g e Q u i n c k e n e e dl e . 5 T h e r e p o r t e d P D P H r a te s

va ry cons ide rab ly , fo r exam ple , P DP H ra te s fo r the 25

gauge Quincke need le range f rom 7. 8 to 37 .2 , 13 15 17-23

and be tween 2 and 9 . 6 fo r the 26 gauge Quincke

needle. 2,15,~9,24-27Wh i le use o f the 29 gauge Quincke nee -

d le has been repor ted to re su l t in an inc idence o f P DP H

be tween 0 and 2 , the fa i lu re ra te o f be tween 1 . 2

and 8 m a y m ak e i t s use im prac t ica l .

20 24 25 28 29

V a r ia b il it y i n t h e r e p o r te d f r e q u e n c y o f P D P H m a y

be a resul t o f differences in pat ient po pulat ion s , such as

age and sex 2,~2 or intraoper at ive variables such as p at ient

pos i t ion, bevel or ienta t ion, t4,3~ type and baric i ty of an-

aes thet ic a gent , 26 addi t ion of opioid 31 and intraope rat ive

s e d at i on . 7 T h e p s y c h o s o m a ti c c o m p o n e n t o f P D P H

should be consid ered 32,33 as well as the defini t ion of

P D P H u s e d a n d t h e m e t h o d o f p a ti e n t f o ll o w -u p e m -

p loyed . The P D P H has been the sub jec t o f recen t rev iew

articles. 34-37

T h i s s t u d y f o u n d a P D P H r a te o f 15 .2 i n y o u n g ,

non-obs te t r i ca l pa t i en t s us ing the 24 gauge S pro t t e nee -

dle . S tudies with the Sprot te needle in obs te tr ical pat ients

sugg ested a P D P H rate of betw een 0 an d 5.6 , 4,22,38-41

a n d a l o w e r i n ci d en c e o f P D P H t h a n w i th t h e 2 5

gau ge, 22,39,a~ the 26 gau ge, 4~ bu t no t the 27 gau ge

Q u i n c k e. a T h e P D P H r a te u s i n g t h e S p r o t t e n e e d le i n

non-obs te t r i ca l anaes thes ia has been repor ted to be be -

tween 2 . 4 7 and 8 . 2 8 and i t o f fe rs no advan tage , wi th

rega rd to P D P H , than e i the r the 25 7,8 o r the 27 gauge

Quinck e need les , i These re su l ts a re d i s appoin t ing a nd

a r e i n c o n t r a st t o t h e P D P H r a te o f 0 . 0 2 f o u n d b y

the need le ' s developer.6

Both need les were judged to have s im i la r d i ff i cu lty o f

placement by the three anaes thet is ts . All had suffic ient

expe r ience us ing the S pro t t e need le tha t the re su l t s o f

th i s s tudy do no t represen t the ea r ly pa r t o f a l ea rn ing

c u r v e .

We chose to l im i t the use o f the Quincke need le wi th

the beve l in the pa ra l l e l o r i en ta t ion because th i s has been

found to dec rease the inc idence o f P DP H a f te r sp ina l

anaes the s ia 14,30 and dura l pun ctu re com plicat ing epid ural

anaes thes ia . 42 Fur ther mo re,

i n v i t r o

s tud ies suppo r t a de -

creased C SF leak with this orienta t ion. 43

A l t h o u g h h a l f o f t h e p a ti e n ts w h o r e p o r t e d a P D P H

desc r ibed the i r wors t sym ptom s as s eve re , no b lood

pa tches were pe r form ed in the 13 pa t i en t s who had a

P D P H i n t h e c o u r s e o f t h i s s t u d y . F e w d a t a e x i s t c o n -

ce rn ing the use o f the 27 need le , 4 bu t these suppo r t o ur

obse rva t ions tha t b lood pa tches a re ra re ly requ i red be -

cause o f re so lu t ion o f sym ptom s w i th in a reasonab le pe -

r iod o f t im e .

This s tudy used a r igorous de f in i t ion o f a P D P H as

a pos tdura l headache , in the f ron ta l o r occ ip i t a l a reas ,

whose sym pto m s w ere aggrava ted by a s sum ing the s i t ting

pos i t ion and a l l ev ia ted by recum bency . 16 M any of the

headaches tha t occur a f t e r sp ina l anaes thes ia m ay no t

be the re su l t o f dura l punc ture and should be d i f fe ren-

t ia ted fro m the PD P H s by the p at ient ' s his tory. 13,25

Th e re lat ive ly h igh ra te o f P D P H tha t we desc ribe

for bo th sp ina l need les requ i re s exp lana t ion . When the

presen t s tudy i s com pared wi th o the rs us ing the 27 gauge

Quinc ke need le , i t appea rs tha t the pa t i en t s in the p resen t

s tudy were younger and fo l lowed up m ore c lose ly than

t h o se r e p o r t e d b y F l a n a g a n

e t a l 1

( P D P H r a t e o f 3 .7 ) .

K a n g

e t a l 2

f o u n d a P D P H r a t e o f o n l y 1 .8 i n a s u b -


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610 CANADIAN JOURNAL OF ANAESTH ESIA

group o f pa t i en t s l es s than 40 y r o f age us ing anaes the t i c

t echn iques and a s ys t em o f fo llow-up simi l a r to ou r own .

S imi la r ly , l ook ing a t s tud ie s us ing the 24 gauge Spro t t e

need le in nonob s te t r i c pa ti en t s we f ind tha t ou r pa t i en t s

w e r e y o u n g e r t h a n t h o s e r e p o r t e d b y T a r k k i l a

et aL 7

(PDPH ra te o f 2 . 4%) who re t i ed on a ques t ionna i re in -

s t ead o f in t e rv iews . Our PDPH ra te i s c los e r to tha t r e -

p o r t e d b y B u t t n e r et al. 8 ( P D P H r a t e 8 . 2 % ) w h o s e p a -

t i en t s we re o lde r than ours bu t who re t i ed on f requen t

in t e rv iews fo r a s even day pos tope ra t ive pe r iod . We be -

l ieve tha t o u r p reope ra t ive in te rv iew, wh ich in fo rms pa -

t i en t s tha t a pos tope ra t ive headache i s a pos s ib le com-

p l i ca t ion o f s p ina l anaes the s i a , combined wi th ou r

me thod o f in t e rv iewing pa t i en t s may have uncove red a

h i g h i n ci d en c e o f tr a n si e n t P D P H s y m p t o m s .

D e s p i te t h e i n c id e n c e o f P D P H , 8 4 .6 % o f p a ti e n ts w e r e

s at is fi ed wi th the con duc t o f the i r anaes the t ic and wou ld

choos e the s ame t echn ique fo r a s imi l a r p rocedure . O the r

s tud ie s have found tha t t he p re fe rence fo r s p ina l anaes -

the s i a i s dampened in thos e who expe r i ence a

PD P H . 2 ,tS:s ,2j,27 Fu rthe rm ore , the overa l l inc idence of

P D P H o f 1 4 % m a y s ti ll c o m p a r e f a v o u r a b l y w i t h th e

more f requen t occur rence o f headache (43%) fo l lowing

genera l a naes thes ia . ~

In co nc lus ion , thi s s tudy s ugges ts tha t t he r i sk o f pos t -

du ra l pu nc tu re headache in young pa t i en t s is s imi l a r a f te r

us ing e i the r the 24 gauge Spro t t e o r the 27 gauge Quinck e

need le s fo r s p ina l anaes the s i a . T he s tudy does no t s up por t

the us e o f the more expens ive Spro t t e need le in young

p a ti e n ts a t r i sk o f P D P H .

eferences

l Flanagan JF, , Ku ma tta D, Blac k D. Comp arison of 24

gauge Sprotte and 27 gauge Quincke needle on the inci-

dence of post dural puncture headache. Anesth Analg

1991; 72: $7 5.

2 Ka ng SB , Go odnou gh DE, Lee YK, e t al. Comparison of

26- and 27-G needles for spinal anesthesia for ambulatory

surgery patients. Anesthesiology 1992; 76: 734-8.

3 Hurley R J , Hertwig LM, Lam bert DH . Incidence of post

dural pun cture headache in the o bstetrical patient: 25

gauge W hitacre vs 26 and 27 gauge Q uincke tip needles.

Reg A nest h 1992; 17: $33.

4 Mayer DC, Q uance D, Weeks SK. Headache after spinal

anesthesia for Cesarean section: a com parion o f the 27-

gauge Quincke and 24-gauge Sprotte needles. Anesth

Analg 1992; 75: 377-80.

5 Cot S, Socci M, Wiesel S. Spinal an aesthesia with the 27

gauge need le. Can J Anaesth 1991; 38: A46 .

6 Sprotte G, Schedel R , P ajunk H. Eine atraumatische

Universalkan ule fur einzeitige Regionalanaesthesien. Reg

Anae sth 198 7; 10: 104-8.

7 Tarkkila P.I,, He ine 11, Tervo R- R. Comparison o f Sprotte

and Quincke needles with respect to post dural pun cture

headache and backache . Reg Anesth 1992; 17: 283-7.

8 Bffttner J,, W resch KP, Klos e R. Biete teine konisch ge-

formte Kantllenspitze Vorteile bei der Spinalanaesthesie?

Reg Anaesth 1990; 13: 124-8.

9 Dixon CL. Th e Sprotte, Whitacre, and Quincke spinal

needles. AnesthesiologyReview 1991; 18: 42-7.

10 C rone L - A L V oge l W . Failed spinal anesthesia with the

Sprotte needle (Letter). Anesthesiology 1991; 75: 717-8.

11 B f i t tner J, Wresch KR Klose R . Few er failed spinal anes-

thestics wi th the Spro tte need le (Letter). Anesthesiology

1992; 77: 393.

12 Vandam LD, Dripps RD. Long-term follow-up of patients

who received 10,098 spinal anaesthetics. JAM A 1956; 161:

586-91.

13 Flaatten H, R od t S, Rosl and J, Vamnes J Postoperative.

headache in yo ung patients after spinal anaesthesia. Anaes-

thesia 1987; 42: 202-5.

14 Lybe cker H, Mr JT, Ma y O, Nielsen HK . Incidence

and prediction of postdural puncture headache. A prospec-

tive study o f 1021 spinal anesthetics. Anesth A nalg 1990;

70: 389-94.

15 Sarma VJ, BostrO'm U Intrathecal anaesthesia for day-care

surgery. A retrosp ective study o f 160 cases using 25- and

26-gauge spinal need les. Anaesthesia 1990; 45: 769 -71.

16 Driessen A, M aue r W, Fricke M, Kossrnann B, Schlein zer

W. P rospective studies on the pathologic mechanism o f

post-spinal headache in a select group of patients. Anaes-

thetist 1980; 29: 38-41 .

17 Crawford JS. Experience with spinal analgesia in a British

obstetric unit. B r J A naesth 1979; 51: 531-5.

18 Flaatten H, Raeder J Spinal anaesthesia for outpatient

surgery. Ana esthesia 1985; 40:1108 -11.

19 Barke r P. Are o bstetric spinal headaches avoidable?

Anaesth Intensive Care 1990; 18: 553-4.

20 Guerts JW, Haanschoten MC , van Wgik RM , K raak H,

Besse TC. Post-dural puncture headache in young patients.

A comparitive study between the use of 0.52 m m (25-

gauge) and 0.33 mm (29-gauge) spinal needles. Acta

Anaesthesiol Scand 1990; 34: 350-3.

21

R asm ussen B S , B lom L , H ansen R M ikke l sen SS .

Postspinal headach e in young and elderly patients. Two

random ised, double-blind studies that com pare 20-and 25-

gauge n eedles. Anaesthesia 1989; 44: 571-3.

22 Cesarini M, Torrielli R, L aha ye F, M en e JM, Cabiro C

Sprotte needle for intrathecal anaesthesia for Caesarean

section: incidence of postdural p uncture headache. A naes-

thesia 1990; 45: 656-8.

23 Ab bo ud TK, Z hu J , Reyes A , e t al . Effect of subarachnoid

morphine o n the incidence of spinal headache. R eg Anesth

1992; 17: 34-6 .

24 D i t tm ann M , R enk l F Spinal anesthesia with extremely

free needles (Letter). Anesthesiology 1989; 70: 1035-6 .


5/5

Wiesel et al.: PDPH: SPROTTE 4 VS QUINCKE 7 611

25 Flaanen H, Ro dt SA , Vamnes J, Rosland J, Wisborg T,

Koller ME. Postdural puncture headache: a comparison

between 26- and 29-gauge needles in you ng patients.

Anaesthesia 1989; 44: 147-9.

26 Naulty JS, Hertwig L, H unt CO, Datta S, O stheimer G W,

Weiss JB. Influence of local anesthetic solution on po st-

dural pu nctu re headache. A nesthesiology 1990; 72:

450-4.

27 Quaynor H, Corbey M, Berg P. Spinal anaesthesia in day-

care surgery with a 26-gauge needle. Br J Anaesth 1990;

65: 766-9.

28

Dah l JB, Schultz P, Anker-MOller E, Christensen EE

Staunstrup HG, C arlsson P. Spinal anaesthesia in young

patients using a 29-gauge needle: technical considerations

and an evaluation of postoperative complaints com pared

with general anaesthesia. Br J An aesth 1990; 64: 178-82.

29 Lynch J, Arhelger S, Krings-Ernst I. Post-dural puncture

headache in young orthopaedic in-patients: comparison of a

0.33 mm (29-gauge) Quincke-type with a 0.7 mm (22-

gauge) Whitacre spinal needle in 200 patients. Acta Anaes-

thesiol S cand 1992; 36: 58-61.

30 Mihic DN. Postspinal heada che and relationship o f needle

bevel to longitudinal dural fibers. Reg Anesth 1985; 10:

76-81.

31 Johnson MD , Hertwig L, Vehring PH, D atta S.

Intrathecal fentanyl may reduce the incidence o f spinal

headache. Anesthesiology 1989; 71: A911.

32 Kaplan G. The psychogenic etiology of headache post

lumbar puncture . P sychosom M ed 1967; 29: 376-9.

33 Daniels AM , Sall ie R. Headache, lum bar puncture , and

expectation (Letter). Lancet 1981; 1: 1003.

34

Gielen M .

Post dural puncture headache (P DP H): a re-

view. Reg A nesth 1989; 14: 101-6.

35 Lambert DH. Complications of spinal anesthesia. Int

Anesthesiol Clin 1989; 27: 51-5.

36 Gerard KW, Fagraeus L. Postspinal headache. Seminars

in Anesthesia 1990; 9: 69-74.

37 Weeks SK. Spinal headache - prevention and treatment.

Can J Anaesth 1990; 37: 53-8.

38 Cambell DC, Douglas MJ, PaW TJC, Flanagan ML,

McMorland GH.

Comp arison of 25G Whitacre vs 24G

Sprotte needles for Caesarean section. Can J Anaesth 1992;

39: A46.

39 Devcic A, Sprung J, Maitra-D Cruze A, Haddox JD.

Post-dural puncture headache in an obstetric population:

com parison o f 24-ga Sprotte and 25-ga Quincke needles.

Reg Anesth 1992; 17: 69.

40 Ross BK, Chadwick HS, M ancuso JJ, Benedetti C.

Sprotte needle for obstetric anesthesia: decreased incidence

of post dural punc ture headache. Reg Anesth 1 992; 17:

29-33.

41 Schneider M, Schuhmacher P, Kaufmann M. Incidence of

postdural puncture headache (P DP H) in young pregnant

and nonpregnant women after spinal anesthesia with a 24G

Sprotte needle. Reg Anesth 1992; 17: 93.

42

Norris MC , Leighton BL, D eSimone CA.

Needle bevel di-

rection and headache after inadvertant dural puncture.

Anesthesiolog y 1989; 70: 729-31.

43 Ready LB, Cuplin S, Haschke RH, Nessly M. Spinal

needle determinants of rate of transdermal fluid leak.

Anesth A nalg 1989; 69: 457-6 0.

44 Fennelly M, Galletly DC, Purdie GI. Is caffeine with-

drawal the mechan ism of postoperative headache? A nesth

Analg 1991; 72: 449-53.

Documents

24 g Sprotte and 27 g Quincke Needle