Kokki H, Heikkinen M, Turunen M, Vanamo K, Hendolin H
Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Finland.
Acta Anaesthesiol Scand. 2000 Feb;44(2):210-3. doi: 10.1034/j.1399-6576.2000.440213.x.
In adults, pencil-point spinal needles are believed to be less traumatic and therefore to be superior compared to cutting-point needles with respect to success rate and postpuncture complications. The aim of this randomised, parallel groups and prospective study was to record the success rate and to evaluate the incidence of complications following spinal anaesthesia with the two types of needles in children.
We studied 215 children aged 1 to 18 years. A 25-gauge needle was used in children up to 7 years (n=96) and a 27-gauge needle in older children (n=119). During lumbar puncture with either a cutting-point (n=109) or a pencil-point (n=106) spinal needle, we recorded puncture characteristics and the success of cerebrospinal fluid (CSF) aspiration. Hyperbaric bupivacaine 5 mg ml(-1) at a dose of 0.3-0.4 mg kg(-1) was used for the spinal anaesthesia. The incidence of postdural puncture complications was recorded from diaries completed by the children and parents one week after the lumbar puncture.
The success rate of the spinal anaesthesia was 97% without difference between the needles. The success rate was higher when the aspiration of CSF was easy compared to if it was difficult (98% vs. 88%, P=0.02). Two hundred and seven diaries were returned (97%). Twenty-four children developed a headache, 8 of which were classified as a postdural puncture headache (PDPH), 6 with the cutting-point needle and 2 with the pencil-point needle (n.s.). Nine children developed signs of transient radicular irritation with no difference between the needles.
Both types of spinal needles can be used in children, and a free aspiration of CSF results in a high success rate of the spinal block. Postpuncture complications are as common in children as in adults.
在成人中，人们认为铅笔头式脊椎穿刺针的创伤较小，因此在成功率和穿刺后并发症方面优于切割头式穿刺针。这项随机、平行组和前瞻性研究的目的是记录成功率，并评估在儿童中使用这两种类型的穿刺针对脊髓麻醉后并发症的发生率。
我们研究了215名1至18岁的儿童。7岁及以下的儿童使用25号穿刺针（n = 96），年龄较大的儿童使用27号穿刺针（n = 119）。在使用切割头式（n = 109）或铅笔头式（n = 106）脊椎穿刺针进行腰椎穿刺时，我们记录了穿刺特征和脑脊液（CSF）抽吸的成功率。脊髓麻醉使用浓度为5 mg ml(-1)的重比重布比卡因，剂量为0.3 - 0.4 mg kg(-1)。通过儿童和家长在腰椎穿刺一周后填写的日记记录硬膜穿刺后并发症的发生率。
脊髓麻醉的成功率为97%，两种穿刺针之间无差异。与脑脊液抽吸困难时相比，抽吸容易时成功率更高（98%对88%，P = 0.02）。共收回207份日记（97%）。24名儿童出现头痛，其中8例被归类为硬膜穿刺后头痛（PDPH），切割头式穿刺针组6例，铅笔头式穿刺针组2例（无统计学差异）。9名儿童出现短暂性神经根刺激症状，两种穿刺针之间无差异。
两种类型的脊椎穿刺针均可用于儿童，脑脊液的顺畅抽吸可使脊髓阻滞成功率较高。穿刺后并发症在儿童中与成人中一样常见。
