Comparison of post-dural puncture headache and low back pain between 23 and 25 gauge Quincke spinal needles in patients over 60 years: Randomized, double-blind controlled trial

Abstract

Background Even though the use of a 25 gauge or smaller Quincke needle is recommended for spinal anesthesia to reduce post-dural puncture headache in Korea, lumbar puncture in older patients using a 25 gauge or smaller Quincke needle can be difficult. However, most previous studies concerning post-dural puncture headache have chosen children, parturients, and young adults as study participants. Objectives The study compared post-dural puncture headache, post-operative back pain, and the number of lumbar puncture attempts using a 23 or 25 gauge Quincke needle for spinal anesthesia of Korean patients >60-years-of-age. Design Randomized, double-blinded controlled trial. Participants The 53 participants who underwent orthopedic surgery under spinal anesthesia were recruited by informed notices from December 2006 through August 2007 at a 200-bed general hospital located in Kyunggido. Inclusion criteria were an age >60 years, ASA I–II, and administration of patient controlled analgesia for the first 48 h post-operatively. Methods The 53 patients were randomly allocated to either the experimental (23 gauge Quincke needle) or control group (25 gauge Quincke needle). All patients had 24 h bed rest post-operatively. Post-dural puncture headache was assessed by the Dittmann Scale and post-operative back pain was assessed by a visual analogue scale at 24, 48, and 72 h post-operatively. The statistical methods included the Mann–Whitney U-test and Spearman correlation. Results There were no differences in post-dural puncture headache, and post-operative back pain at 24, 48, and 72 h post-operatively, and no differences in the number of lumbar punctures, with the 23 and 25 gauge Quincke needle. Forty-eight hour post-operative back pain was positively associated with the number of lumbar punctures ( p = .036) and age ( p = .040). There were no statistically significant associations among post-dural puncture headache, the number of lumbar punctures, and 48 h post-operative back pain. Pre-operative back pain was positively associated with 48 h post-operative back pain ( p < .001). Conclusions The choice of a 23 or 25 gauge Quincke needle for spinal anesthesia has no significant influence on post-dural puncture headache and post-operative back pain for Korean patients greater than 60-years-of-age. The 23 gauge Quincke needle is an option for lumbar punctures in this patient population.