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Category: Volume 08 Issue 07 July 2020
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Title: Incidence of Post Dural Puncture Headache (PDPH) Following Subarachnoid Block with 25G & 27G Quincke Spinal Needles in Patients Posted for lower Abdominal Surgery

Authors: Dr Chandra Bhushan Kumar, Dr. Ashutosh Kumar Jha

 DOI: https://dx.doi.org/10.18535/jmscr/v8i7.09

Abstract

Introduction: Post dual puncture headache (PDPH)  first described by Augustus Bier in 18984 from his personal experience following a failed attempt of spinal anesthesia  on himself  due to mechanical difficulty. However his Assistant Hildebrandt4 successful in this regard in the same year and he also experienced PDPH. Two most important predictors of (PDPH) are type of spinal needle and its size5,6. In 1951 Hart and Whitacre7 reported lower PDPH rates with pencil point needle (Whitacre) than cutting (Quincke) type of needle. Till date, numerous studies demonstrated lower incidence of PDPH following spinal anaesthesia with the use of smaller size spinal needle in comparison to larger one.

Method: The study was a randomized, single blind, non placebo comparative study which includes 130 patients with ASA grade I & II of either sex, between the ages 25 years to 50 years going for lower abdominal surgery. cases was divided randomly into two groups: Group A with 25G and Group B with 27 G Quincke needles. 3.5ml 0.5% Bupivaccine heavy was injected intrathecally at either L2-L3 or L3-L4 interspace in every patient after computer generated Randomization.

Result: In our study it is observed that the percentage of PDPH in group A  21%  and that of group B  4.6%. Group A & Group B were comparable with regard to age, sex distribution & ASA  grading  so no statistical significant difference were found with regard to these parameters.

Conclusion: It can be concluded from our study, large bore cutting type of spinal needle (25G Quincke), producesmore  PDPH than  small bore cutting type of spinal needle (27G Quincke).

References

  1. Bier A. Experiments regarding the cocainization of the spinal cord. Dtsch Z Chir. 1899; 51: p. 361-369.
  2. Marx G. The first spinal anesthesia. Who deserves the laurels? RegAnesth.1994; 19: p. 429–430.
  3. Dripps R, Vandam L. Long-term follow-up of patients who received 10,098spinal anesthetics: failure to discover major neurologic sequelae. JAMA. 1954;156: p. 1486–1491.
  4. Gerancher JC, Liu SS: complications of Neuraxial (spinal/epidural/caudal) Anaesthesia In : Jonathan LB, Lawrence JS Anaesthesia  and Perioperative complications. 2nd edition .Mosby ;1999,p.50-65
  5. Reid JA,Thorburn J. editorial II Headache after spinal anaesthesia. Br J Anaesth 1991;67:674-7.
  6. Kang SB, Goodnough DE, Lee YK, et al. A Comparison of 26G and 27G needles for spinal anaesthesia for ambulatory surgery patients. Anaesthesiology 1992;76(5):734-8
  7. Goodman Gilman Pharmocology: 12th edition; page 697 Miller’s Anesthesia: 7thedition; page no. 814.
  8. Miller Anesthesia: 7th edition; page no. 929
  9. Wayne Kleinman, Maged Mikhial spinal <epidural and caudal blocks. In: GE Morgan, MSMIkhial, MJ Murray. Clinical Anesthesiology 4th edition 2006, page no. 319.
  10. Gerrtse BM, Gielen MJ. Seven months delay for epidural blood patch in PDPH. Eur J Anesthesiol 1999;16:650-1.
  11. Zeidon A, Farhat O, Maaliki H, Baraka A. Does PDPH left untreated lead to subdural haematoma? Case report and review of literature. Int J ObstetAnesth 2006;15 (1):50-8.
  12. Grieff J, Cousins MJ. Subdural- arachnoid and extradural anaesthesia. In Nimmo WS, Row Botham DJ, Smith G. Anasethesia 2nd edition Blackwell Scientific publication London 1994:p1411-54.
  13. Ahan S, Kitchen N, Jenkins C, Margary J. Incidence of PDPH following spinal anaesthesia  for lower segment caesarean section with 25G polymedic spinal needle. J Pak Med Assoc 1996;46:278-81.
  14. Hopkinson JM, Samaan AK, Russell IF, Birks RJS, Patrick MR. A comparative multicentre trial of spinal needles caesarean section anaesthesia 1997;52: 998-1014.
  15. Garry M, Davies S. Failure of regional blockade for caesarean section. Int J Obstet Anesth 2002;11:9-12.
  16. Lambert DH, Herley RJ, Hertwig L, Datta S. Role of needle gauge and tip configuration in the production of lumbar puncture headache. Reg Anesth 1997; 22:66-72.
  17. McConachie I, Mc Geachie J. Regional anaesthetic techniques in: Thomas EJH, Peter JC. Wylie and Churchill- Davidson’s A practice of Anesthesia, 67th edition 1995;page 718.
  18. Nazli H, Subhana T, Tayyab M. spinal anaesthesia for caesarean section. JSP 2002,7(1):19-21.
  19. Roheena W, Nasreen L, Fayyaz AQ, Akbar SJ. The frequency of PDPH in different age groups. J Coll Physicians Surg Pak 2006;16(6):389-92.
  20. Lynch J, Kasper SM, Strick K, Topalidis K, Schaff H, Zeeh D, Krings- Ernst I. The use of Quincke and Whitacre 27G in orthopedic patients: incidence of  spinal anaesthesia and PDPH. AnesthAnalg 1994:79:124-8.

Corresponding Author

Dr Chandra Bhushan Kumar

Junior Resident, Department of Anaesthesiology, KMC, Katihar, India