Central Hospital, Kyunggido, Republic of Korea.
Int J Nurs Stud. 2011 Nov;48(11):1315-22. doi: 10.1016/j.ijnurstu.2011.04.005. Epub 2011 May 10.
Even though the use of a 25 gauge or smaller Quincke needle is recommended for spinal anesthesia to reduce post-dural puncture headache in Korea, lumbar puncture in older patients using a 25 gauge or smaller Quincke needle can be difficult. However, most previous studies concerning post-dural puncture headache have chosen children, parturients, and young adults as study participants.
The study compared post-dural puncture headache, post-operative back pain, and the number of lumbar puncture attempts using a 23 or 25 gauge Quincke needle for spinal anesthesia of Korean patients >60-years-of-age.
Randomized, double-blinded controlled trial.
The 53 participants who underwent orthopedic surgery under spinal anesthesia were recruited by informed notices from December 2006 through August 2007 at a 200-bed general hospital located in Kyunggido. Inclusion criteria were an age >60 years, ASA I-II, and administration of patient controlled analgesia for the first 48 h post-operatively.
The 53 patients were randomly allocated to either the experimental (23 gauge Quincke needle) or control group (25 gauge Quincke needle). All patients had 24 h bed rest post-operatively. Post-dural puncture headache was assessed by the Dittmann Scale and post-operative back pain was assessed by a visual analogue scale at 24, 48, and 72 h post-operatively. The statistical methods included the Mann-Whitney U-test and Spearman correlation.
There were no differences in post-dural puncture headache, and post-operative back pain at 24, 48, and 72 h post-operatively, and no differences in the number of lumbar punctures, with the 23 and 25 gauge Quincke needle. Forty-eight hour post-operative back pain was positively associated with the number of lumbar punctures (p=.036) and age (p=.040). There were no statistically significant associations among post-dural puncture headache, the number of lumbar punctures, and 48 h post-operative back pain. Pre-operative back pain was positively associated with 48 h post-operative back pain (p<.001).
The choice of a 23 or 25 gauge Quincke needle for spinal anesthesia has no significant influence on post-dural puncture headache and post-operative back pain for Korean patients greater than 60-years-of-age. The 23 gauge Quincke needle is an option for lumbar punctures in this patient population.
在韩国，建议使用 25 号或更小规格的 Quincke 针进行脊椎麻醉，以减少硬膜穿刺后头痛，但对于老年患者，使用 25 号或更小规格的 Quincke 针进行腰椎穿刺可能较为困难。然而，之前的大多数关于硬膜穿刺后头痛的研究都选择儿童、产妇和年轻成年人作为研究对象。
本研究比较了使用 23 号或 25 号 Quincke 针进行脊椎麻醉时，韩国>60 岁患者的硬膜穿刺后头痛、术后腰痛和腰椎穿刺次数。
随机、双盲对照试验。
2006 年 12 月至 2007 年 8 月，在京畿道一家 200 张床位的综合医院，通过知情通知招募了 53 名接受脊椎麻醉下骨科手术的患者。纳入标准为年龄>60 岁、ASA I-II 级和术后 48 小时内使用患者自控镇痛。
53 名患者随机分为实验组（23 号 Quincke 针）和对照组（25 号 Quincke 针）。所有患者术后均卧床 24 小时。术后 24、48 和 72 小时通过 Dittmann 量表评估硬膜穿刺后头痛，通过视觉模拟量表评估术后腰痛。统计方法包括 Mann-Whitney U 检验和 Spearman 相关分析。
两组患者术后 24、48 和 72 小时的硬膜穿刺后头痛和腰痛无差异，23 号和 25 号 Quincke 针的腰椎穿刺次数也无差异。术后 48 小时腰痛与腰椎穿刺次数呈正相关（p=.036）和年龄（p=.040）。硬膜穿刺后头痛、腰椎穿刺次数与术后 48 小时腰痛无统计学显著相关性。术前腰痛与术后 48 小时腰痛呈正相关（p<.001）。
对于韩国>60 岁的患者，脊椎麻醉中选择 23 号或 25 号 Quincke 针对硬膜穿刺后头痛和术后腰痛无显著影响。对于该患者人群，23 号 Quincke 针是腰椎穿刺的一种选择。
