Gosch U W, Hueppe M, Hallschmid M, Born J, Schmucker P, Meier T
Department of Anaesthesiology, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany.
Br J Anaesth. 2005 May;94(5):657-61. doi: 10.1093/bja/aei100. Epub 2005 Feb 18.
To reduce the risk of post-dural puncture headache (PDPH) in continuous spinal anaesthesia, small-gauge spinal catheter systems with different techniques of dural perforation have been developed.
Two systems, the catheter through-needle technique (MicroCatheter, Portex, UK) and the catheter over-needle technique (22G Spinocath, B. Braun, Germany), were used in 18 young healthy volunteers (age 18-30 yr), who were enrolled in a neuroendocrinological investigation for analysis of neuropeptides in cerebrospinal fluid (CSF). After intermittent sampling of CSF (17 x 0.5 ml over 4 h), the catheter was removed and the development of PDPH and pain intensity were documented prospectively by the subjects in a standardized headache assessment (11-point numerical rating scale [NRS]).
The study revealed a high overall incidence of PDPH (78%) with no significant differences between groups (P=0.26). However, the over-needle group showed a significantly shorter duration of PDPH (2.4 [SD 2.3] vs 5.1 [3.1] days, P=0.050) and lower maximum pain intensity (3.1 [2.9] vs 7.3 [3.4] NRS, P=0.014) than the through-needle group.
The results demonstrate a potential benefit of the catheter over-needle technique for the reduction of the duration and intensity of PDPH.
为降低连续脊麻后发生头痛（PDPH）的风险，已研发出采用不同硬膜穿刺技术的细规格脊麻导管系统。
两种系统，即导管套针法（MicroCatheter，英国Portex公司）和导管针芯法（22G Spinocath，德国贝朗公司），应用于18名年轻健康志愿者（年龄18 - 30岁），这些志愿者参与了一项神经内分泌学调查，以分析脑脊液（CSF）中的神经肽。在间歇性采集脑脊液（4小时内采集17次，每次0.5毫升）后，拔除导管，受试者通过标准化头痛评估（11点数字评分量表[NRS]）前瞻性记录PDPH的发生情况和疼痛强度。
研究显示PDPH的总体发生率较高（78%），两组之间无显著差异（P = 0.26）。然而，针芯法组的PDPH持续时间明显较短（2.4[标准差2.3]天对5.1[3.1]天，P = 0.050），最大疼痛强度较低（3.1[2.9]对7.3[3.4]NRS，P = 0.014），优于套针法组。
结果表明导管针芯法在减少PDPH的持续时间和强度方面具有潜在益处。
