25G Quincke Needle Research Articles

THORACIC SEGMENTAL SPINAL ANAESTHESIA IN UPPER ABDOMINAL SURGERIES AND SIMPLE MASTECTOMY-A CASE SERIES

Objective: To observe safety and efficacy of Segmental thoracic spinal anesthesia (STSA) in upper abdominal and breast surgeries. Methods: 14 cases were selected, out of which 6 laparoscopic cholecystectomy (LC), 4 open cholecystectomy (OC), 3 emergency exploratory laparotomy and 1 simple mastectomy. Under full aseptic precaution, segmental thoracic spinal anesthesia was administered through midline approach in T8-9 space for upper abdominal surgeries and T5-6 space in a simple mastectomy. Using 25G Quincke spinal needle 1.5 ml [7.5 mg] of 0.5% Isobaric Levobupivacaine mixed with 0.4 ml (20µg) Fentanyl was given in abdominal surgeries and 1.2 ml [6 mg] of 0.5% Isobaric Levobupivacaine mixed with 0.4 ml (20µg) Fentanyl in simple mastectomy. Results: Age group of patients ranged from 25 to 65 y, Male: Female ratio of 4:10, Body Mass Index (BMI) range of 22 to 24.9 with physiological status of ASA I to ASA III. Hemodynamically, hypotension was observed in every patient after 5-10 min of STSA well managed with fluid and vasopressors with no bradycardia. Average width of sensory block was T3 to L1-2 in upper abdominal surgeries and T1 to T8 in a simple mastectomy. Motor block was Modified Bromage Scale (MBS) of 0 to 1 during and postoperatively. Regarding analgesia, Visual Analogue Scale (VAS) score was 0 intraoperatively and 0-1 postoperatively. Sedation score was 2 both intraoperatively and postoperatively with no significant complications and good patient and surgeon satisfaction. Conclusion: Segmental thoracic spinal anaesthesia is a safe and effective procedure with good patient and surgeon satisfaction.

Post dural puncture headache following subarachnoid block for caesarean section: A comparision between 25G and 27G Quincke spinal needle

Post dural puncture headache following subarachnoid block for caesarean section: A comparision between 25G and 27G Quincke spinal needle

Study to compare the incidence of post-dural puncture headache in obstetric patients using cutting and pencil-point spinal needle in spinal anesthesia

Background: Spinal anesthesia is one of the most commonly used regional anesthesia techniques. Post-dural puncture headache (PDPH) is a well-known iatrogenic consequence of spinal anesthetic and diagnostic lumbar puncture, primarily caused by loss of cerebral spinal fluid. To reduce complications, spinal needles have undergone modifications. The two most important modifiable risk variables for PDPH were needle shape and size. In young expecting mothers, post-cesarean sections are associated with an increased incidence of PDPH. Aims and Objectives: The aims and objectives of the study are to compare the incidence of PDPH in obstetric patients using cutting and pencil-point spinal needles following spinal anesthesia. Materials and Methods: This 1-year double-blind study was carried out in the Department of Anaesthesia from August 2021 to July 2022. The study comprised obstetric patients who were scheduled for elective-segment cesarean section. The subarachnoid block needle was divided into Groups A and B at random: Group A 25-gauge Whitacre spinal needle with a pencil point, whereas Group B 25-gauge Quincke spinal needle with a cutting bevel. Records were kept on age, height, weight, and gestational age. A follow-up was conducted up until the discharge date. The incidence and severity of PDPH after spinal anesthesia were examined in both groups. The results were analyzed with SPSS 20.0, and the Fischer exact and Chi-square tests were used to look for statistical significance. Results: The current study included 120 patients in total, 60 patients in each of Groups A and B. When a pencil point Whitacre was used, the incidence of PDPH was 2 (3.3%), however, when a cutting Quincke needle was used, the incidence was 7 (10.8%). With a P < 0.05, the relationship between the two was considered statistically significant. The pain severity was mild in both patients of Group A. Of the seven patients in Group B, four had mild pain, two had moderate pain, and one had severe pain. Conclusion: The pencil-point 25-G Whitacre spinal needle has a lower incidence of PDPH than the traditional 25-G Quincke needle and was suggested for patients at risk of PDPH. In light of this, the current study suggested using pencil-point spinal needles for lumbar punctures and spinal anesthesia in obstetric patients.

Infiltration Between Popliteal Artery and Capsule of the Knee Combined with Adductor Canal Block as Analgesic Adjuvant During and Postoperative in Total Knee Replacement Surgery

Background: Infiltration between the popliteal artery and capsule of the knee (iPACK) is one method that has been proposed in recent years as a potential alternative to peripheral nerve block as analgesia in total knee replacement (TKR) procedures. This study presents anesthetic management using spinal anesthesia combined with iPACK and adductor canal block (ACB) in patients with grade IV osteoarthritis who underwent TKR of the right knee.
 Case presentation: A woman, a housewife aged 50 years, was planning to undergo TKR surgery. The patient came with complaints of pain in the right knee 1 year before entering the hospital. The patient was given supplemental oxygen with a nasal cannula at 3 liters per minute. Prior to spinal anesthesia, the patient was given fentanyl 25 mcg iv, ketamine 10 mg iv, and midazolam 1.5 mg IV as premedication. The patient was positioned on the right side, and a 27G Quincke needle was inserted at the level of L3-L4 and given bupivacaine heavy 0.5% 7.5 mg, then lateralized for 15 minutes. After lateralization, the patient was positioned supine and used ultrasound to direct ACB action with a regimen of ropivacaine 0.25% + dexamethasone 5 mg a volume of 20 ml, then iPACK was performed with a regimen of Ropivacaine 0.375% + dexamethasone 5 mg a volume of 20 ml. After surgery, the patient is treated in the recovery room for 1 hour until bromage score is 0. The patient received the PCA Morphine analgesic demand only 1 mg/mL, 1 mg per dose, max 5 mg over 4 hours, lockout interval 6 minutes; Paracetamol 500 mg every 6 hours PO; Ibuprofen 400 mg every 8 hours PO.
 Conclusion: TKR patients who were given analgesia using the ACB peripheral nerve block technique combined with iPACK experienced a decrease in pain levels and lower use of postoperative morphine so that patient mobilization was faster and reduced the patient's length of stay.

EFFECTIVENESS OF 25G COMPARED TO 27G QUINCKE SPINAL NEEDLE IN REGARD OF POST-DURAL PUNCTURE HEADACHE IN OBSTETRICS PATIENTS UNDERGOING SPINAL ANESTHESIA

Post-Dural puncture headache (PDPH) is a distressing complication that can occur following a dural puncture during spinal anesthesia. It is believed to arise from cerebrospinal fluid leakage and subsequent reflex cerebral vasodilation. Notably, PDPH occurs more frequently in young parturient women undergoing Caesarean sections. This study aims to evaluate the frequency of PDPH in patients undergoing elective Caesarean delivery, comparing the use of 25G and 27G Quincke spinal needles during spinal anesthesia. A randomized controlled trial was conducted at Aziz Bhatti Shaheed Teaching Hospital's anesthesiology department in Gujrat from March 2022 to March 2023. A total of 140 parturient women with an American Society of Anesthesiologists (ASA) physical status classification of I to II, who underwent Caesarean sections, were included in the study. Exclusion criteria encompassed patients with infection at the injection site, severe hypervolemia, coagulopathy, increased intracranial pressure, severe aortic and mitral stenosis, severe preeclampsia, placenta previa grade–IV, placenta accreta, and twin pregnancy. The participants were divided into groups (Group I and Group II), each comprising 70 individuals. Spinal anesthesia was administered in the sitting posture using 25G Quincke spinal needles for Group I and 27G Quincke spinal needles for Group II. The puncture sites were the L3-4 or L4-5 intervertebral spaces. The incidence of PDPH was evaluated at 6, 12, 24, and 48 hours following the surgical procedure. Quantitative data, such as age, were presented as mean ± SD, while qualitative data were reported as frequency and percentages. Statistical significance was defined as a P-value < 0.05. The age range of the patients included in the study was 18 to 40 years. The mean age of patients in Group I was 26.12 ± 5.82 years, while in Group II, it was 26.34 ± 5.30 years. Eleven patients (15.71%) in Group I experienced PDPH, unlike three (4.28%) in Group II. The difference in PDPH incidence between the two groups was statistically significant (p = 0.031). Our findings indicate that using a 27G Quincke spinal needle for spinal anesthesia during Caesarean sections confers a distinct advantage in reducing PDPH occurrence compared to the 25G Quincke spinal needle. The results strongly support the superiority of the 27G Quincke spinal needle in minimizing the occurrence of PDPH.

Post-Spinal Backache! A Myth or an Overlooked Complication

Objective: To find out the difference in the backache when a 27G Quincke needle with no more than two attempts is used for spinal anaesthesia versus general anaesthesia.
 Study Design: Prospective comparative study.
 Place and Duration of Study: Anesthesia Department, Combined Military Hospital, Lahore Pakistan, from Jun 2020 to May 2021.
 Methodology: A total of 150 patients were divided into two Groups. C-sections were performed under general and spinal anaesthesia in Group-GA and Group-SA, respectively. General anaesthesia was induced with intravenous anaesthetics following rapid sequence induction. The 27G Quincke needle was used for spinal anaesthesia with no more than two attempts. Post-operative follow-ups for backache were carried out at 24-hours, 1, 4 and 12 weeks.
 Results: At 24-hours post-operative follow-up, 8 patients from the GA-Group and 17 from the SA-Group had backache; the difference was significant (p-value of 0.049). At week-1, two patients from the GA-Group and five from the SA-Group complained of backache (p-value 0.246). Similarly, at week-4, only one patient from the GA Group and four from the SAGroup had backache (p-value 0.127). At the 12-week follow-up, only one patient complained of backache, and she belonged to the SA- Group (p-value 0.316).
 Conclusion: Spinal anesthesia results in a significantly high frequency of backache as compared to general anaesthesia in the immediate post-operative period; however, there is no long-term difference in backache.

Postdural puncture headache incidence with 25G and 27G Quincke needles after spinal anesthesia for elective cesarean section

Background: Post dural puncture headache(PDPH) is a bilateral occipito-frontal headache occurs in 0.1 to 36% of cases receiving spinal anesthesia. We evaluated the incidence of PDPH after spinal anesthesia using two commonly used needles, 25G and 27G Quincke needles among females undergoing elective cesarean section. Aims and Objectives: The aim of the study was to compare the post-dural puncture headache with 25G And 27G Quincke Needle – in terms of Incidence, severity in patients after spinal anesthesia for elective caesarean section and to find out number of attempts for successful block and any associated complications. Materials and Methods: Six hundred females of ASA grade I or II posted for elective cesarean section under spinal anesthesia were enrolled into two equal groups to assess incidence of PDPH in the post-operative period. They were assessed by a blinded observer for the onset of headache, characteristics, duration, severity, and any associated symptoms for 5 days. PDPH was defined as postural headache that was aggravated by sitting or standing position and relieved by lying supine. Results: The incidence of PDPH was 11% in 25G needle group and 6.33% in the 27G needle group [Risk Ratio of 0.58 (95% CI: 0.34, 0.99)]. In none of the groups, intensity of headache was severe while all were mild in the 27G group. Nausea and vomiting were the only associated symptomatology, 7.33% in the 25G group and 5.67% in the 27G group. Conclusion: The results support 27G Quincke needle to administer spinal anesthesia in females undergoing elective cesarean section.

Clinical evaluation of perfusion index (PI) as a predictor of post spinal hypotension in lower segment caesarean section (LSCS)

Hypotension is a common complication, subsequently spinal anaesthesia in lower segment caesarean section, which can cause adverse maternal & foetal outcomes. A new decisive research area in obstetric anaesthesia is prevention & early treatment of spinal hypotension to improve maternal & foetal outcomes. A novel parameter, Perfusion index (PI) is tried during sub arachnoid block for predicting hypotension in lower segment caesarean section (LSCS). In this study, 60 parturient belonging to ASA status 1 or 2 with apparent pregnancies scheduled for elective LSCS received spinal anaesthesia with 2ml of 0.5% heavy bupivacaine by using an orange (25G) Quincke needle at L3-L4 or L4-L5 interspinous space. Haemodynamics & perfusion index were recorded at regular intervals. Baseline perfusion index was correlated with degree of hypotension by using Receiver Operative Characteristic curve. Baseline perfusion index & other parameters were correlate by Karl Pearson correlation method. : In our study 34.5% incidence of hypotension among study theme & momentous correlation between fall in systolic blood pressure from baseline & baseline perfusion index (r = 0.436; P < 0.05). The optimal utmost point for perfusion index was found to be 3.5 with a sensitivity of 37% & specificity of 97%. A higher incidence of hypotension was found in Parturient having baseline perfusion index more than 3.5 following sub arachnoid block in elective LSCS.

Abstract No. : ABS3624: Comparison of monitored anaesthesia care using dexmedetomidine with spinal anaesthesia using ropivacaine in day care varicose vein surgery

Background &Aims:The purpose of this study was to compare the safety and efficacy of monitored anaesthesia care(MAC)using dexmedetomidine with spinal anaesthesia(SA) using ropivacaine in day care varicose vein surgery in terms of patient satisfaction and postoperative ambulatory and discharge time.Methods:64 patients who underwent varicose vein surgery were randomly divided into two groups.GROUP I MAC(n=32) GROUP II SA(n=32).In the MAC group, a loading dose of 1µg/kg dexmedetomidine was administered followed by 0.6µg/kg/min maintainance infusion which was then titrated according to sedation. Fentanyl was given as rescue anagesia. In the SA group ,SAwas given with 10mg of 0.5 % ropivacaine by a median/paramedian approach in L3/L4 interspace with 25G Quincke spinal needle. Patient’s satisfaction to anaesthesia and post operative ambulatory time and discharge time were recorded.Results:Significantly higher verbal numerical rating scale for patient’s satisfaction to anaesthesia’ was observed in patients of Group I as compared to Group II. Ambulatory time was significantly earlier in Group I as compared to Group II .Range of ambulatory time in Group I was 2 to 5 hours while that in Group II was 4 to 6:30 hours . Group I patients were discharged earlier than Group II though significant differences were not found.Conclusion:Monitored anaesthesia care using dexmedetomidine with fentanyl as rescue analgesia isa better alternative for day care varicose vein surgery due to its association with better patient satisfaction and early ambulatory time and early discharge compared to spinal anaesthesia using ropivacaine.

Incidence and Severity of Postdural Puncture Headache following Subarachanoid Block using 25G Quincke and 25G Whitacre Spinal Needles: A Double-blinded, Randomised Control Study

Introduction: Postdural Puncture Headache (PDPH) is the most common complication of dural puncture. Clinical studies have shown that use of small guage needles with pencil point tip is associated with lower incidence and severity of PDPH than with cutting tip needles. Aim: To compare the incidence and severity of PDPH between 25G cutting (Quincke) and 25G non cutting (Whitacre) needles. Materials and Methods: In this randomised controlled study conducted at Jawaharlal Nehru Institute of Medical SciencesImphal, Manipur, India from September 2019 to September 2021. A total of 150 patients of both sexes, age <60 years and American Society of Anaesthesiologists (ASA) grade I and II, undergoing lower abdominal or lower limb surgeries under spinal anaesthesia were enrolled for this study and divided into two groups with 75 patients in each group. Spinal anaesthesia was performed with 25G Quincke needle in one group and 25G Whitacre needle used in other group to compare the incidence and severity of PDPH (severity was determined by limitation of patient activity and treatment required). Results: Overall 14 patients (9.33%) developed PDPH – 2 in the Whitacre spinal needle (2.6%), and 12 in the Quincke spinal needle (16%), with p-value of 0.009. The incidence of failed spinal anaesthesia was significantly higher with Whitacre spinal needle 12 (16%) than with Quincke needle 4 (5.3%), with p-value of 0.03. Incidence of PDPH was more in female patients 12 (14.8%) compared with male patients 2 (2.9%),with p-value of 0.018. Severity of PDPH ranged from mild (n=10) to moderate (n=2) in Quincke needle group, whereas in Whitacre group patients had only mild form of PDPH (n=2). Conclusion: Incidence and severity of PDPH was significantly lower in 25G Whitacre spinal needle than 25G Quincke needle. Failure rate of spinal anaesthesia was more in Whitacre needle than in Quincke needle.

Evaluation of Effect of Hip/Shoulder-Width Ratio on the Sensory Level of Spinal Anesthesia - A Prospective Observational Study.

Background:Certain anthropometric measurements that are practically obtainable explain the variability in the spread of spinal anesthesia. These are useful for quick assessment of the spread of spinal anesthesia to avoid the risk of high block and also the inadequate level of block.Aims:The study aims to evaluate the effect of hip/shoulder-width ratio (HSR) on the sensory level of spinal anesthesia.Settings and Design:This prospective observational study was undertaken at a tertiary care hospital.Statistical Analysis:Pearson's correlation and multiple linear regression analyses were used to analyze the relationship between study variables with the level of sensory block.Materials and Methods:One hundred patients undergoing various surgical procedures were enrolled for the study. With a patient in a sitting position, hip-width was measured between the two iliac crests, shoulder-width was measured between two acromion processes, and vertebral column length was noted by measuring the distance from C7 vertebra to sacral hiatus. 3 mL of 0.5% hyperbaric bupivacaine was administered intrathecally at L3–L4 with 25G Quincke's needle in the lateral position. Assessment of block level was done by loss of cold sensation and loss of pinprick sensation every 5 min till 30 min. The numbers of segments blocked were noted from the S5 segment. The relationship between various factors with the level of sensory block was analyzed by the Pearson's correlation coefficient.Results:HSR and body mass index (BMI) have a significant correlation with the sensory level of spinal anaesthesia, HSR (r = 0.297, P < 0.05) and BMI (r =0.385, P < 0.05).Conclusion:HSR can help predict the cephalad spread of spinal anesthesia. We can expect a higher level of sensory blockade of spinal anesthesia in females who generally have an HSR more than one.

Frequency of Post Dural Puncture Headache with Quincke 25g and Quincke 27g Spinal Needle after Spinal Anaesthesia

Objective: To compare the frequency of post dural puncture headache with Quincke 25G and Quincke 27G of spinal needles for spinal anesthesia. Design of the Study: It’s a Randomized control trial. Study Settings: This study was carried out Department of anesthesiology and Intensive Care Unit, Shaikh Zayed Hospital Lahore from 29-08-2020 to 01-03-2021. Material and Methods: In this prospective study 100 patients were enrolled who were decided to undergo spinal anesthesia. Two groups were made by randomization. In patients of group I, anesthesia was administered by using 25G quincke needle while 27G quincke needle was used for patients in group II. Evaluation of patients was with regard to development of postoperative PDPH within 3-days. Groups were compared by using Chi-square test and a P-value&lt;0.05 was taken statistically significant. Results of the Study: PDHD was seen in 14 (28%) patients in group I and in 4 (8%) patients in group II. Statistically, the difference between the two groups was significant (p&lt;0.05).. Conclusion: Due to less frequency of PDPH with 27G needle, it should be given preference for applying spinal anesthesia over 25G needle. Keywords: Spinal anesthesia, post dural puncture headache; quincle needle.

A Comparison of Incidence of Post Dural Puncture Headache Using 25G Quincke and 25G Whitacre Needle in Obstetric Patients Undergoing Caesarean Section under Spinal Anesthesia

Introduction: Spinal anesthesia has offered a new armamentarium for the anesthesiologists and has been widely used in the Cesarean section in the field of obstetrics, an alternative to general anesthesia. However, Post Dural Puncture Headache remains an inevitable complication of spinal anesthesia and can be minimized its incidence by reducing the size of the needle and changing the design of the needle tip. The objective of the study was to find the incidence of post-dural puncture headache undergoing subarachnoid block for CS using 25G Quincke and 25G Whitacre needles.&#x0D; Materials and methods: This study was conducted from August 2020 to January 2021 enrolling 72 parturients and were allocated in two groups of 36 each. Group A and B parturients received spinal anesthesia via. 25G Quincke and 25G Whitacre in sitting position respectively. All the patients were evaluated based on incidence, onset, duration, and severity of headache postoperatively for 72 hours after the subarachnoid block.&#x0D; Results: The incidence of post-dural puncture headache in the study was 7.2% in Group A and 3.15% in Group B which was statistically significant (P-value = 0.011), while there were no significant differences between these two groups in the onset, severity, and duration of post-dural puncture headache.&#x0D; Conclusion: Despite no significant differences were found for the onset, severity, and duration of post-dural puncture headache, the use of 25G Whitacre is associated with a reduced incidence of post-dural puncture headache compare to 25G Quincke.

To Study the Role of Perfusion Index as a Predictor of Hypotension during Spinal Anesthesia in Lower Segment Cesarean Section - A Prospective Observational Study.

Background and Aims:Spinal anesthesia has become the choice of neuraxial anesthesia for cesarean delivery. Hypotension, the most common side effect of spinal anesthesia is more in parturients. Perfusion index (PI) is one of the newest methods, used noninvasively for the prediction of hypotension postspinal anesthesia, evaluation of regional block success, and a tool for pain assessment. In our study, we have used PI for predicting the occurrence of hypotension postsubarachnoid block in elective lower segment cesarean section (LSCS).Methods:In this prospective observational study, parturients posted for elective LSCS under spinal anesthesia were included. Spinal anesthesia was performed at L3-L4 interspace using 25G (gauge) Quincke needle, with 1.8 mL of 0.5% hyperbaric bupivacaine plus 20 μg fentanyl. Hypotension was defined as a decrease in systolic blood pressure >25% from the baseline.Statistical Analysis Used:Statistical analysis was performed using the paired sample t-test, Chi-square test, and independent t-test.Results:From our study, we had found that a positive correlation exists between the baseline PI of the patient and the occurrence of hypotension intraoperatively. A cutoff value of 1.75 (with P < 0.001) was found to be significant; above which the occurrence of hypotension was definite. The sensitivity of this cutoff value was 75% and specificity was 71% for this value.Conclusion:Baseline perfusion of >1.75 can predict hypotension postspinal anesthesia in LSCS. The incidence of hypotension was about 93% in parturients whose baseline was above the cutoff value.

The interrelation between body mass index and post-dural puncture headache in parturient women.

Background and Aims:Post-dural puncture headache is seen more frequently in pregnant women due to stress, dehydration, intra-abdominal pressure, and insufficient fluid replacement after delivery. Obesity protects against post-dural puncture headache in pregnant women; increased intra-abdominal fat tissue reduced cerebrospinal fluid leakage by increasing the pressure in the epidural space. Therefore, this study investigated the influence of body mass index on post-dural puncture headache in elective cesarean section patients in whom 27G spinal needles were used.Material and Methods:The study included 464 women who underwent elective cesarean section under spinal anesthesia. Dural puncture performed with a 27G Quincke spinal needle at the L3-4 or L4-5 intervertebral space and given 12.5 mg hyperbaric bupivacaine intrathecally. The patients were questioned regarding headache and low back pain 6, 12, 24, and 48 h after the procedure, and by phone calls on days 3 and 7.Results:Post-dural puncture headache developed in 38 (8.2%) patients. Of the patients who developed post-dural puncture headache, 23 (60.5%) had a body mass index <30 and 15 (39.5%) had a body mass index ≥30. Of the patients who did not develop post-dural puncture headache, 258 (60, 6%) had a body mass index <30 and 168 (39, 4%) had a body mass index ≥30.Conclusion:This prospective study found the body mass index values did not affect post-dural puncture headache in the elective cesarean section performed under spinal anesthesia.

To Compare Frequency of Post Dural Puncture Headache with Quincke 25g and Quincke 27g Needles for S/A

Aim: Frequency of post dural puncture headache with Quincke 25G and 27G needles for spinal anesthesia Design of study: Control randomized study Setting: Anesthesiology/ deptt. / ICU, Shaikh Zayed Hospital Lahore Duration: 29-08-2013 to 01-03-2014 for 6 months Methodology: This was a prospective study of 100 patients undergoing surgery under spinal anesthesia. The subjects were divided in two groups. In group I, the anesthesia was applied with 25G quincke needle and in group II, the anesthesia was applied with 27G quincke needle. The patients were evaluated for post dural puncture headache till 72 hours postoperatively. Chi-square test was applied. P &lt;0.05 was taken as significant. Results: PDPH was seen in 14 (28%) subjects in group I and in 4 (8%) subjects in group II. Conclusion: 27G needle should be preferred over 25G needle for application of spinal anesthesia due to decreased PDPH Keywords: Post dural puncture headache; spinal anesthesia; quincke needle

Post Dural Puncture Headache After Elective Caesarean Section Using 27 G Quincke and Whitacre Spinal Needles: A Comparative Study

INTRODUCTION&#x0D; Post-dural puncture headache (PDPH), a serious complication of spinal anesthesia (SA) may persevere for long time and can be unbearable to the patients. The incidence of PDPH unswervingly relies on the size of the spinal needles used and this gradually decreases with the use of thinner spinal needles.&#x0D; &#x0D; MATERIAL AND METHODS&#x0D; A prospective randomized single blinded study was conducted during the period between 1 to 29 January 2019, at Universal College of Medical Sciences, Nepal. A total of 120 patients (between 20-35 years of age) were divided into two groups: Group I: 60 patients given SA with 27-G Quincke needle and Group II: 60 patients given SA with 27-G Whitacre. Randomization was done by coin tossing method and double-blinded except for the anesthetist performing the spinal block. Patients were interviewed on days 1 to 5 and were questioned with regard to headache based on its severity, location, character, duration, associated symptoms (nausea, vomiting, auditory and ocular symptoms). The severity of the headache was analyzed by Crocker scale.&#x0D; &#x0D; RESULTS&#x0D; The results showed that 33% more headache in group A, but the t-value was 0.727 and p-value was 0.2345 which was statistically insignificant.&#x0D; &#x0D; CONCLUSION&#x0D; Hence, using 27-G Quincke spinal needles does appear to be advantageous to the patients whereas, Whitacre spinal needles are shown to be clearly associated with fewer cases of PDPH.

English

BACKGROUND Spinal anaesthesia is the first preference of anaesthesia in obstetric surgery. Post dural puncture headache (PDPH) is more common after C-section in young parturients. In the present world which is developing and fast-paced, brisk recovery along with minimal side effects &amp; importantly early ambulation are now the need of the hour. This headache is more worrying to the mother who is required to tend to the newborn baby. This study compared the incidence of PDPH subsequent to subarachnoid blockade for lower segment Caesarean section (LSCS) 25G Whitacre &amp; 25G Quincke needles. We wanted to compare the incidence of PDPH using 25G Quincke and 25G Whitacre spinal needles in patients undergoing LSCS. METHODS Two hundred (ASA II) American Society of Anaesthesiologists 11 females who were pregnant and in the age group of 20 - 50 years, planned to get sub-arachnoid blockade for C-section, were assigned randomly into two equal groups (N = 100 each). Both groups received spinal anaesthesia with 25-gauge Quincke and 25 gauge Whitacre needle. Postoperatively, incidence, site, onset, severity and duration of headache was studied. RESULTS The incidence of post spinal headache was 6 % in the Quincke group. No patients in Whitacre group had PDPH. The number of lumbar punctures required for successful sub arachnoid block was recorded in both the groups. 92 % patients from group Q and 88 % patients from group W required only one puncture. 8 % patients from group Q and 12 % patients from group W required two punctures. CONCLUSIONS It is prudent to conclude that 25G Whitacre spinal needle is a better alternative to 25G Quincke needle for reducing the incidence of post dural puncture headache in patients undergoing lower segment Caesarean section. KEY WORDS Spinal Anaesthesia, Post Dural Puncture Headache, Caesarean Section

Effect of high altitude on the incidence of postdural puncture headache in young males: A 5-year restrospective study

Background: Postdural puncture headache (PDPH) is a serious and debilitating complication and a major cause of postoperative morbidity occurring after spinal anesthesia (SA) or inadvertent dural puncture after epidural anesthesia. The understanding of pathophysiology of PDPH has improved over the last few decades and its occurrence is now on decrease with use of better techniques and smaller gauge needles. Over the past several years, many of the risk factors attributable to PDPH have been identified and studied extensively, but only few studies have evaluated the effect of increasing altitude on the occurrence of PDPH. As a significant proportion of population undergo surgery in such elevations, we retrospectively evaluated the effect of high altitude on the incidence of PDPH following SA. Materials and Methods: This study was conducted at a single center, retrospective observational study in the high altitude and cold climate region, for a period of 5 years. The data collected were evaluated for the occurrence of PDPH. Results: The total number of cases undergoing surgery under SA in our center was 440 over a period of 5 years. The cumulative incidence of PDPH in this cohort was 6.6%. The incidence was 7.15% and 5.56% with use of 26G and 27G Quincke needle, respectively, which is higher than that observed in the low-lying areas. Conclusions: The incidence of PDPH is higher in patients undergoing surgery under SA at high altitude.

A Clinical Study to Compare 25 G Whitacre and Quincke Spinal Needles for Incidence of Post Dural Puncture Headache (PDPH) and Failed Spinal Anaesthesia

Post dural puncture headache (PDPH) is the most distressful complication of spinal anaesthesia. The modifiable risk factors include spinal needle type and size. Thus the present study was attempted with a primary aim to compare 25G Whitacre and 25G Quincke spinal needles with respect to the incidence, onset and severity of PDPH, incidence of failed spinal anaesthesia (FSA) and the quality of block achieved (sensory and motor). The study was conducted from December 2017 to August 2019. 120 patients posted for lower abdominal and lower limb surgeries were allocated in two groups of 60 each. Patients received sub arachnoid block (SAB) with 15 mg of 0.5% bupivacaine using 25 G Whitacre needle in Group A and using 25G Quincke’s needle in Group B. All the patients were evaluated for incidence, onset and severity of PDPH at 24hr, 48hrs and 72hrs after SAB, rate of FSA and quality of block using modified bromage scale and pinprick method. Demographic data was comparable in both the groups. Incidence of PDPH was 1.6% in Whitacre group as compared to 15% in Quincke’s group . However the result was statistically insignificant for rate of FSA and quality of block achieved. It is concluded that pencil point 25 G Whitacre needles are associated with a lower incidence of PDPH as compared to cutting 25G Quincke spinal needle and thus should be used in a population that is at high risk of developing PDPH.