Puolakka R, Jokinen M, Pitkänen M T, Rosenberg P H
Department of Anaesthesiology, Helsinki University Central Hospital, Töölö Hospital, Finland.
Reg Anesth. 1997 Nov-Dec;22(6):521-6.
The tips of the bevels of thin spinal needles may be easily damaged by bony contact during puncture attempts. In this respect and also because they are less traumatic by design, noncutting, pencil-point-tip needles may be beneficial. A prospective clinical comparison of postanesthetic effects of the use of 27G Quincke-type and pencil-point spinal needles was therefore performed.
The study included 400 spinal anesthesia patients, in 200 of whom the initial needle was a 27-gauge Quincke type, a 27-gauge pencil-point needle being used in the other 200. Altogether, 464 needles had to be used; in 30 cases the pencil-point needle was replaced by a 27- or 25-gauge Quincke-type needle. A block performance form was filled in, and the patients were interviewed personally on the first postoperative day and by means of a mailed questionnaire on the 14th day.
The tips of the Quincke-type needles were distorted in a blunt, bent or hooked manner in 13% of the initial and 14% of the final needles. The severity of the damage was related to the count category of bony contacts during puncture (0, 1-4, or 5 or more). The occurrence of postdural puncture headache was not, however, related either to damage of the needles or to the number of puncture attempts. Diffuse (not posture-dependent) headache occurred more often after the use of the Quincke-type needle than after use of the pencil-point needles, the tips of which remained intact in each case.
Postanesthetic sequelae, including postdural puncture headache (overall incidence 2.5%), were not related to the shape of the spinal needles or to the damage of the Quincke-type needles.
在穿刺尝试过程中，细脊麻针斜面的尖端可能因与骨质接触而容易受损。在这方面，由于其设计上创伤较小，非切割型铅笔尖针可能有益。因此，对使用27G Quincke型和铅笔尖脊麻针后的麻醉效果进行了一项前瞻性临床比较。
该研究纳入了400例接受脊麻的患者，其中200例最初使用的是27G Quincke型针，另外200例使用的是27G铅笔尖针。总共使用了464根针；在30例中，铅笔尖针被27G或25G Quincke型针替代。填写了一份阻滞操作表格，并在术后第一天对患者进行了个人访谈，在第14天通过邮寄问卷进行了调查。
Quincke型针的尖端在13%的初始针和14%的最终针中出现钝圆、弯曲或钩状变形。损伤的严重程度与穿刺过程中骨质接触的计数类别（0、1 - 4或5及以上）有关。然而，硬膜穿刺后头痛的发生与针的损伤或穿刺尝试次数均无关。使用Quincke型针后比使用铅笔尖针后更常出现弥漫性（与体位无关）头痛，而铅笔尖针的尖端在每种情况下均保持完整。
包括硬膜穿刺后头痛（总发生率2.5%）在内的麻醉后后遗症与脊麻针的形状或Quincke型针的损伤无关。
