Kokki H, Hendolin H, Turunen M
Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Finland.
Acta Anaesthesiol Scand. 1998 Oct;42(9):1076-82. doi: 10.1111/j.1399-6576.1998.tb05379.x.
In the last decade the use of spinal anaesthesia (SA) in paediatric anaesthesia has increased. In adults, pencil point spinal needles are supposed to be less traumatic and hence to be superior compared with cutting point needles in respect of postpuncture complaints. In children, the use of spinal needles with a special tip design have not been compared. The aim of this study was to study the clinical utility and postpuncture characteristics of four newly designed spinal needles in paediatric surgery.
In this open-randomised, parallel groups, prospective study we compared the puncture quality, success rate and postpuncture characteristics in 200 children aged 2 to 128 months. Two cutting point needles; a 50-mm-long 25G Quincke and a 25-mm-long 26G Atraucan were compared with two pencil point needles; a 37-mm-long 27G Whitacre and a 35-mm-long 24G Sprotte. The children were premedicated with oral diazepam and those anxious or uncomfortable after premedication were sedated with i.v. thiopentone or propofol. Bupivacaine 5 mg ml-1 0.3-0.5 mg kg-1 was used for the SA.
The spinal puncture was successful with one or two skin punctures in 96% of children. The cutting point needles were easier to insert through the skin and ligaments (P = 0.001) but the pencil point needles gave a better (P = 0.001) indication of the dural passage. The success rate of the SA was 91% without differences between the needles. Five patients were given general anaesthesia and 13 children a single dose of i.v. fentanyl/sedative. The spinal block was completed in less than 3 min in 96% of the cases without differences between the needles. Seventeen children developed a headache, 10 of which were classified as a postdural puncture headache (PDPH), 3 with the Sprotte, 3 with the Quincke and 4 with the Atraucan needles. The youngest child developing PDPH was a 12-month-old boy. Eight of the PDPH were mild and 2 moderate. Ten children developed a low back pain, 2-3 in each study group. Three children in the pencil point groups developed signs of transient radicular irritation.
SA using bupivacaine and the study needles produced smooth and safe anaesthesia for paediatric surgery with a high success rate. PDPH after SA is as common in children (5%) as in adults although most often mild and short lasting. SA using bupivacaine can cause transient radicular irritation.
在过去十年中，脊髓麻醉（SA）在小儿麻醉中的应用有所增加。在成人中，铅笔尖脊髓穿刺针被认为创伤较小，因此在穿刺后不适方面优于切割尖针。在儿童中，尚未对具有特殊尖端设计的脊髓穿刺针的使用进行比较。本研究的目的是研究四种新设计的脊髓穿刺针在小儿外科手术中的临床实用性和穿刺后特征。
在这项开放随机、平行组的前瞻性研究中，我们比较了200名年龄在2至128个月的儿童的穿刺质量、成功率和穿刺后特征。将两根切割尖针（一根50毫米长的25G Quincke针和一根25毫米长的26G Atraucan针）与两根铅笔尖针（一根37毫米长的27G Whitacre针和一根35毫米长的24G Sprotte针）进行比较。儿童术前口服地西泮，术前焦虑或不适的儿童静脉注射硫喷妥钠或丙泊酚进行镇静。使用浓度为5毫克/毫升、剂量为0.3 - 0.5毫克/千克的布比卡因进行脊髓麻醉。
96%的儿童经一或两次皮肤穿刺脊髓穿刺成功。切割尖针更容易穿过皮肤和韧带（P = 0.001），但铅笔尖针能更好地（P = 0.001）指示硬膜穿刺。脊髓麻醉的成功率为91%，各针之间无差异。5例患者接受了全身麻醉，13名儿童静脉注射了单剂量的芬太尼/镇静剂。96%的病例脊髓阻滞在不到3分钟内完成，各针之间无差异。17名儿童出现头痛，其中10例被归类为硬膜穿刺后头痛（PDPH）——3例使用Sprotte针，3例使用Quincke针，4例使用Atraucan针。发生PDPH的最年幼儿童是一名12个月大的男孩。8例PDPH为轻度，2例为中度。10名儿童出现腰痛，每个研究组2 - 3例。铅笔尖针组中有3名儿童出现短暂性神经根刺激症状。
使用布比卡因和本研究中的穿刺针进行脊髓麻醉可为小儿外科手术提供平稳、安全的麻醉，成功率高。脊髓麻醉后PDPH在儿童中的发生率（5%）与成人相同，尽管大多为轻度且持续时间短。使用布比卡因进行脊髓麻醉可引起短暂性神经根刺激。
