Morros-Viñoles C, Pérez-Cuenca M D, Cedó-Lluís E, Colls C, Bueno J, Cedó-Vallobá F
Servicio de Anestesiología, Reanimación y Terapia del Dolor, Centro hospitalario MIDAT MUTUA (Mutua Metalúrgica de Accidentes de Trabajo), Barcelona.
Rev Esp Anestesiol Reanim. 2002 Nov;49(9):448-54.
Post-dural puncture headache and lumbar backache are related to needle gauge and type of point used. We aimed to determine whether the incidence of post-dural puncture headache and lumbar backache could be reduced by using fine gauge pencil-point Sprotte 27G and 29G needles. We also studied increases in technical difficulty with these needles and whether or not reducing needle gauge affected anesthetic quality.
Three hundred eighty-nine patients undergoing orthopedic or lower abdominal surgery were randomly assigned to two groups for dural puncture using two Sprotte needles: 27G or 29G. We recorded time to perform puncture, number of re-insertations of the needle, number of times the technique was abandoned and anesthetic efficacy. On the second and seventh days, the patients were interviewed by telephone to check for the presence and severity of post-dural puncture headache or lumbar backache.
The technical difficulty was greater with the Sprotte 29G needle, as shown by significant differences in time taken to perform the puncture and the number of re-insertions (p < 0.05). Anesthetic quality was the same in both groups and the percentage of failures was 0.5% for both. Five percent of patients in the 27G group and 3% in the 29G group experienced slight or moderate headache on the second day. No cases of severe cephalea were reported. Lumbar backache was reported on the second day by 26% and 18.5% of the patients in the 27G and 29G groups, respectively, but the rates decreased to 4.5% and 0.5% on the seventh day. The differences were significant, favoring the 29G needle.
The use of 29G pencil-point needles can be recommended to reduce the incidence of headache and lumbar backache in the postoperative period, in spite of the greater technical difficulty involved, given that quality of anesthesia is maintained.
硬膜穿刺后头痛和腰背痛与穿刺针规格及穿刺点类型有关。我们旨在确定使用细规格笔尖式Sprotte 27G和29G穿刺针是否可以降低硬膜穿刺后头痛和腰背痛的发生率。我们还研究了使用这些穿刺针时技术难度的增加情况以及减小穿刺针规格是否会影响麻醉质量。
389例接受骨科手术或下腹部手术的患者被随机分为两组，分别使用两种Sprotte穿刺针（27G或29G）进行硬膜穿刺。我们记录了穿刺时间、穿刺针重新插入次数、放弃该技术的次数以及麻醉效果。在术后第二天和第七天，通过电话对患者进行访谈，以检查是否存在硬膜穿刺后头痛或腰背痛及其严重程度。
Sprotte 29G穿刺针的技术难度更大，穿刺时间和重新插入次数存在显著差异（p < 0.05）。两组的麻醉质量相同，两组的失败率均为0.5%。27G组5%的患者和29G组3%的患者在术后第二天出现轻微或中度头痛。未报告严重头痛病例。27G组和29G组分别有26%和18.5%的患者在术后第二天报告有腰背痛，但在第七天时，这一比例分别降至4.5%和0.5%。差异具有统计学意义，支持使用29G穿刺针。
尽管使用29G笔尖式穿刺针技术难度更大，但鉴于麻醉质量得以维持，推荐使用该穿刺针以降低术后头痛和腰背痛的发生率。
