Buettner J, Wresch K P, Klose R
Department of Anesthesiology and Intensive Care, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Germany.
Reg Anesth. 1993 May-Jun;18(3):166-9.
To evaluate the influence of the shape of the needle tip on postdural puncture headache (PDPH) independent of the needle diameter, a 25-gauge Whitacre and a 25-gauge Quincke needle were compared.
In a prospective, randomized, double-blind fashion, the study was carried out on 400 patients who received spinal anesthesia for operations of the lower extremities. The 25-gauge Whitacre needle (group 1) and the 25-gauge Quincke needle (group 2) were randomly assigned to the patients, 200 in each group. Patients were interviewed postoperatively on days 1, 3, 5, and 7 using a standardized questionnaire. Only postural headache was defined as PDPH. The intensity of both postural and nonpostural headache were quantified using a 4-point rating scale and a visual analog pain scale (VAS). Statistical analysis was performed with parametric and nonparametric tests when appropriate, p < or = 0.05 was considered as significant.
There were no differences in age and sex distribution between the two groups. Significantly more patients in group 2 (8.5%) complained of PDPH than in group 1 (3%, p < or = 0.02). Duration of PDPH ranged from 1-3 days (median: 1) in group 1, and from 1-9 days (median: 3) in group 2. This difference closely approached significance (p = 0.058). The mean maximal intensity of PDPH was comparable in both groups. Severe PDPH occurred only in two patients of group 2. One of them required a blood patch. With respect to the nonpostural headache, no significant differences were seen.
The use of a conical tipped Whitacre needle results in significantly less PDPH compared to a standard Quincke spinal needle of the same size.
为了评估针尖形状对腰穿后头痛（PDPH）的影响，而不考虑针的直径，对25G的Whitacre针和25G的Quincke针进行了比较。
采用前瞻性、随机、双盲方式，对400例接受下肢手术脊髓麻醉的患者进行研究。将25G的Whitacre针（第1组）和25G的Quincke针（第2组）随机分配给患者，每组200例。术后第1、3、5和7天使用标准化问卷对患者进行访谈。仅姿势性头痛被定义为PDPH。姿势性和非姿势性头痛的强度均使用4分制评分量表和视觉模拟疼痛量表（VAS）进行量化。在适当的时候进行参数和非参数检验，p≤0.05被认为具有显著性。
两组患者的年龄和性别分布无差异。第2组（8.5%）抱怨PDPH的患者明显多于第1组（3%，p≤0.02）。第1组PDPH的持续时间为1 - 3天（中位数：1天），第2组为1 - 9天（中位数：3天）。这种差异接近显著性（p = 0.058）。两组PDPH的平均最大强度相当。严重PDPH仅发生在第2组的两名患者中。其中一名患者需要进行血补丁治疗。关于非姿势性头痛，未观察到显著差异。
与相同尺寸的标准Quincke脊髓针相比，使用圆锥形针尖的Whitacre针导致的PDPH明显更少。
