Devcic A, Sprung J, Patel S, Kettler R, Maitra-D'Cruze A
Department of Anesthesiology, Medical College of Wisconsin, St. Joseph's Hospital, Milwaukee 53226.
Reg Anesth. 1993 Jul-Aug;18(4):222-5.
Postdural puncture headache (PDPH) is a frequent complication of spinal anesthesia. Some investigators have recommended the use of the Sprotte needle to reduce the incidence of this serious complication. This study prospectively compared the incidence of PDPH with two spinal needles of different size and design: the 24-gauge Sprotte (noncutting point) versus the 25-gauge Quincke (diamond, cutting point). The hypothesis that subarachnoid fentanyl will reduce the incidence of PDPH, as suggested in the literature, was also studied.
Only patients for emergency or elective cesarean delivery were studied. One hundred ninety four patients were randomly assigned to receive spinal anesthesia with one of the two needles (Sprotte, n = 96; Quincke, n = 98). Simultaneously, each patient was assigned to receive hyperbaric 0.75% bupivacaine local anesthetic or a combination of the same concentration of local anesthetic with 20 micrograms of fentanyl (Sprotte with fentanyl, n = 47; Sprotte without fentanyl, n = 49; Quincke with fentanyl, n = 49; Quincke without fentanyl, n = 49). All patients were evaluated during the first 4 postoperative days, and follow-up telephone interviews were conducted 3 weeks after discharge.
Four patients (4.2%) in the Sprotte group and seven (7.1%) in the Quincke group developed PDPH. Three out of four patients with headache in the Sprotte and four out of seven in the Quincke group received fentanyl as an adjunct for spinal anesthesia. Two patients in the Sprotte group required an epidural blood patch as a therapy for PDPH. Two patients in the Quincke group had severe headache and required an epidural blood patch.
In the current study, the use of the 24-gauge Sprotte spinal needle resulted in a low incidence of severe PDPH, but was not significantly different when compared with the use of a 25-gauge Quincke needle (oriented parallel to the longitudinal dural fibers). The addition of fentanyl to hyperbaric bupivacaine spinal anesthesia did not reduce the risk of PDPH.
硬膜穿刺后头痛（PDPH）是脊髓麻醉常见的并发症。一些研究者推荐使用Sprotte针以降低这种严重并发症的发生率。本研究前瞻性地比较了两种不同尺寸和设计的脊髓穿刺针导致PDPH的发生率：24G的Sprotte针（非切割尖端）与25G的Quincke针（菱形，切割尖端）。还研究了如下假设，即如文献中所提示的，蛛网膜下腔注射芬太尼会降低PDPH的发生率。
仅纳入接受急诊或择期剖宫产手术患者进行研究。194例患者被随机分配，接受两种穿刺针之一进行脊髓麻醉（Sprotte针组，n = 96；Quincke针组，n = 98）。同时，每位患者被分配接受重比重0.75%布比卡因局部麻醉，或相同浓度局部麻醉药与20微克芬太尼的联合使用（Sprotte针+芬太尼组，n = 47；Sprotte针无芬太尼组, n = 49；Quincke针+芬太尼组，n = 49；Quincke针无芬太尼组，n = 49）。在术后第1个4天内对所有患者进行评估，并在出院后3周进行随访电话访谈。
Sprotte针组有4例患者（4.2%）发生PDPH，Quincke针组有7例（7.1%）。Sprotte针组4例头痛患者中有3例、Quincke针组7例中有4例在脊髓麻醉时接受了芬太尼作为辅助用药。Sprotte针组有2例患者需要硬膜外血贴治疗PDPH。Quincke针组有2例患者出现严重头痛，需要硬膜外血贴治疗。
在本研究中，使用24G的Sprotte脊髓穿刺针导致严重PDPH的发生率较低，但与使用25G的Quincke针（与硬脊膜纤维纵轴平行）相比，差异无统计学意义。重比重布比卡因脊髓麻醉中添加芬太尼并未降低PDPH的风险。
