Comparison of the effects of sagittal versus transvers 25-gauge quincke needle insertion on post-dural puncture headache development
Article Sidebar
Main Article Content
Abstract
Objective: Post-dural puncture headache (PDPH) is one of the most important complications after spinal anesthesia. This study aimed to investigate the effect of the sagittal or transverse application of 25-gauge Quincke spinal needle on PDPH development in patients undergoing cesarean section.
Material and Methods: A total of 295 patients with a planned cesarean section between the ages of 18-40 years with an American Society of Anesthesiologists score of 1 or 2 were included in the study. For the spinal intervention, 25-gauge Quincke spinal needle was used in all patients. Patients were included in one of two groups according to the spinal needle cutting direction of the dura mater fibers as sagittal (parallel to dura mater fibers, Group S; n=145) or transverse group (perpendicular to dura mater fibers, Group T; n=150).
Results: PDPH developed in 27 (9.2%) patients. Patients in Group T had significant higher ratio of PDPH compared to patients in Group S (16% vs. 2.1%, p<0.001). Additionally, patients with PDPH had a significantly higher frequency of ≥2 spinal puncture attempts compared to patients without PDPH (22.2% vs. 4.5%, p=0.003). Multivariate logistic regression analysis demonstrated that transverse needle direction (OR: 11.40, 95% CI: 2.73-34.71; p<0.001) and ≥2 spinal puncture attempts (OR: 9.73, 95% CI: 3.13-41.55; p<0.001) and were independent predictors for PDPH development.
Conclusion: Transverse insertion of the 25-gauge Quincke needle into spinal cord fibers and repeated interventions are independently associated with the development of PDPH in cesarean section patients undergoing spinal anesthesia
Downloads
Article Details
Accepted 2020-07-10
Published 2020-07-16
References
Ranasinghe JS, Steadmann J, Toyama T, Lai M. Combined spinal epidural anaesthesia is better than spinal or epidural alone for Caesarean delivery. Br J Anaesth 2003;91(2):299–300.
Gaiser R. Postdural puncture headache. Curr Opin Anaesthesiol. 2006;19(3):249-53.
Wail N Khraise, Mohammed Z Allouh, Khaled M El-Radaideh, Raed S Said, and Anas M Al-Rusan. Assessment of risk factors for postdural puncture headache in women undergoing cesarean delivery in Jordan: a retrospective analytical study. Local Reg Anesth. 2017;10:9-13.
Miller RD. Miller’s Anesthesia. Vol. 2. Issue: Churchill Livingstone; 2010. p. 1626-7.
Robert R. Gaiser MD. Postdural Puncture Headache. Anesthesiology Clinics. 2017;35(1):157-167
Evans RW, Armon C, Frohman EM, Goodin DS. Assessment: prevention of post-lumbar puncture headaches: report of the therapeutics and technology assessment subcommittee of the american academy of neurology. Neurology. 2000;55(7):909-14.
Choi PT, Galinski SE, Takeuchi L, Lucas S, Tamayo C, Jadad AR. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Can J Anaesth. 2003;50(5):460-9.
Zorrilla-Vaca A, Mathur V, Wu CL, Grant MC. The Impact of Spinal Needle Selection on Postdural Puncture Headache: A Meta-Analysis and Meta regression of Randomized Studies. Reg Anesth Pain Med. 2018;43(5):502-508
Halpern S, Preston R. Post dural puncture headache and spinal needle design. Anesthesiology 1994;81:1376–83.
Lambert DH, Herley RJ, Hertwig L, Datta S. Role of needle gauge and tip configuration in the production of lumbar puncture headache. Reg Anesth 1997;22:66–72
Shaikh JM, Memon A, Memon MA, Khan M. Post dural puncture headache after spinal anaesthesia for caesarean section: A comparison of 25 g Quincke, 27 g Quincke and 27 g Whitacre spinal needles. J Ayub Med Coll Abbottabad 2008;20:10‑3.
Xu H, Liu Y, Song W, Kan S, Liu F, Zhang D, Ning G, Feng S. Comparison of cutting and pencil-point spinal needle in spinal anesthesia regarding postdural puncture headache: A meta-analysis. Medicine (Baltimore). 2017;96(14):e6527.
Flaatten H, Thorsen T, Askeland B, Finne M, Rosland J, Hansen T, et al. Puncture technique and postural postdural puncture headache. A randomised, double-blind study comparing transverse and parallel puncture. Acta Anaesthesiol Scand 1998;42:1209-14.
Norris MC, Leighton BL, DeSimone CA. Needle bevel direction and headache after inadvertent dural puncture. Anesthesiology 1989;70:729-31.
Lotfy Mohammed E, El Shal SM. Efficacy of different size Quincke spinal needles in reduction of incidence of Post-Dural Puncture Headache (PDPH) in Caesarean Section (CS). Randomized controlled study. Egyptian Journal of Anaesthesia. 2017; 33(1): 53-58.
Kocamanoğlu İS, Sarıhasan B, Şener B, Tür A, Şahinoğlu H, Sunter T, authors. Retrospective analysis of the effects of anesthesia methods applied in cesarean sections and complications. Retrospective analysis of 3552 cases. Turk Klinikleri J Med Sci. 2005;25:810–6.
Holst D, Möllmann M, Ebel C, Hausman R, Wendt M. In vitro investigation of cerebrospinal fluid leakage after dural puncture with various spinal needles. Anesth Analg. 1998;87:1331–5.
Salik F, Kiliç ET, Akelma H, Güzel A. The Effects of the Quincke Spinal Needle Bevel Insertion on Postdural Puncture Headache and Hemodynamics in Obstetric Patients. Anesth Essays Res. 2018;12(3):705-710.
Ready LB, Cuplin S, Haschke RH, et al. Spinal needle determinants of rate of transdural fluid leak. Anesth Analg. 1989;69:457– 460
Zorrilla-Vaca A, Makkar JK. Effectiveness of Lateral Decubitus Position for preventing Post-Dural Puncture Headache: A Meta-Analysis. Pain Physician. 2017;20(4):E521-E529.
Xu, Z., Yao, X., Zhang, Y., Chen X, Zhou X, Shen F, Liu Z. Efficacy of different positions for neuraxial anesthesia in caesarean section: a meta-analysis. Int J Clin Exp Med. 2016;9(10):20255-20267.
Obasuyi BI, Fyneface-Ogan S, Mato CN. A comparison of the haemodynamic effects of lateral and sitting positions during induction of spinal anaesthesia for caesarean section. Int J Obstet Anesth. 2013;22(2):124-8.
Coppejans HC, Hendrickx E, Goossens J, Vercauteren MP. The sitting versus right lateral position during combined spinal-epidural anesthesia for cesarean delivery: block characteristics and severity of hypotension. Anesth Analg. 2006;102(1):243-7.
Laithangbam PK, Singh NR, Fanai RL, Singh SS, Shashank DS, Nayagam HA. Comparision of lateral, Oxford and sitting positions for combined spinal and epidural ansthesia for elective caesarean section. Journal of Medical Society 2013; 27(1):70-4.
Reynolds F. Identifying the epidural space. In: Norris MC, ed. Obstetric Anesthesia. Philadelphia: JB Lippincott, 1993: 307–18.
Öztürk I, Sirit I, Yazicioglu D. A retrospective evaluation of the effect of patient position on postdural puncture headache: Is sitting position worse. Anaesth Pain & Intensive Care 2015; 19:130-34
Pirbudak L, Özcan HI, Tümtürk P. Postdural puncture headache: Incidence and predisposing factors in a university hospital. Agri. 2019;31(1):1-8
Bezov D, Lipton RB, Ashina S. Post‑dural puncture headache: Part I diagnosis, epidemiology, etiology, and pathophysiology. Headache 2010;50:1144‑52
Khraise WN, Allouh MZ, El-Radaideh KM, Said RS, Al-Rusan AM. Assessment of risk factors for postdural puncture headache in women undergoing cesarean delivery in Jordan: a retrospective analytical study. Local Reg Anesth. 2017;10:9-13