Quincke Spinal Needle Research Articles

Fascicular injury is rare following needle transfixion: a study on median and ulnar isolated human nerves

BackgroundNeedle trauma has been associated with peripheral nerve injury and neurological dysfunction. However, inadvertent needle puncture is frequent while postblock dysfunction is rare. We conducted a cadaveric study to evaluate...

Incidence of post-dural lumbar puncture headache (PDLPH) in comparison between emergency and elective lower segment cesarean section (LSCS) with 26G Quincke-Babcock cutting-beveled spinal needle.

C-section is usually performed under spinal anesthesia also known as a subarachnoid block (SAB) over general anesthesia. Because of the lesser amount of dose used, there is a lower risk of local anesthetic toxicity and minimal transfer of drugs to the fetus. Obstetric patients have a higher risk of having post-dural puncture headache (PDPH). PDPH occurs due to leakage of the cerebrospinal fluid (CSF) through the hole created by a spinal needle. There are many elements affecting the frequency of PDPH, these elements can also consist of age, female sex, needle size, and types, pregnancy, preceding records of PDPH, median-paramedian distinction in approach, a puncture level. PDPH is commonly in the form of a frontal, occipital, or retro-orbital headache that starts in 12-72 h after the dural puncture and will increase when standing and decrease when lying down or resting. We aimed to learn about headache frequency between elective and emergency lower segment cesarean section using 26-G Quincke spinal needle in full-term pregnant patients. To study the incidence of PDPH using the 26G Quincke spinal needle. To analyze the causal factors/determinants such as adequate preloading of fluids, size of spinal needle, number of pricks, and technique of lumbar puncture effects on the incidence of PDPH. This study is a prospective questionnaire-based comparative observational study using the convenience sampling method. The patients were interviewed with a structured questionnaire at the Symbiosis University Hospital and Research Centre, Lavale, Pune. The patients observed for the study were between 20 and 40 of age group, posted for emergency or elective lower segment cesarean section, with body mass index (BMI) less than 14.5 to 24.9 and with ASA I and II grades. Patients with any comorbidities, recurrent headaches, obesity, and spine deformity were excluded. According to the review of the literature and with the help of a formula, the sample size was calculated as 20; 10 patients for elective LSCS, and 10 patients for emergency LSCS. Out of 20 patients, 10 patients were posted for elective LSCS, and the rest 10 patients were for emergency LSCS under spinal anesthesia. The incidence of PDPH was found only in 2 out of 10 emergency LSCS patients, and no patients from elective LSCS cases showed up with the incidence of PDPH.

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.

COMPARISON OF 25 G WHITACRE AND QUINCKE SPINAL NEEDLES FOR INCIDENCE OF POST-DURAL PUNCTURE HEADACHE

The retrospective study was conducted in tertiary care hospital from June 2022 to December 2022 to compare the severity and incidence of PDPH in patients administered spinal anesthesia for lower limb and lower abdominal surgeries using 25G Whitacre and 25G Quincke needles. A sample size of 140 70 in each of the two groups (group Quincke and group Whitacre) was included in the study. Results showed that 11 (15.7%) patients in group Quincke and 1 (1.4%) patient in group Whitacre had PDPH (P=.009). Females had a higher incidence of PDPH (P=0.018). Of 12 patients, 11 had mild, and 1 had moderate PDPH. 11 patients in group Whitacre and 3 in group Quincke had failed spinal anesthesia. 25G Whitacre spinal needles showed lower incidence and severity of post-dural puncture headache than 25G Quincke spinal needles.

A PROSPECTIVE RANDOMIZED INTERVENTIONAL STUDY TO DETERMINE THE INFLUENCE OF SPINAL FLEXION VERSUS EXTENSION IN THE LATERAL DECUBITUS POSITION ON THE UNILATERALITY OF SPINAL ANESTHESIA USING HYPERBARIC BUPIVACAINE FOR ELECTIVE UNILATERAL LOWER LIMB SURGERIES

Objective: A restricted sympathetic block during spinal anesthesia may minimize hemodynamic changes and advantageous in view of maintaining stable cardiovascular profile through intraoperative period. Methods: This prospective randomized interventional study was conducted on a total of 150 patients of either sex aged 20-50 years of American Society of Anesthesiologists grades 1 and 2 were randomly allocated in two groups (75 in each group).Using a 25-gauge Quincke spinal needle, 7.5 mg of 0.5% hyperbaric bupivacaine was injected over a period of 80s at L3-L4 interspace in both groups. Patients were kept in flexion or extension according to belonging groups: Group A (flexion) or Group B (extension) after drug administration for15 min of lateral decubitus position, then patients were turned to supine position. Results: Strict unilateral sensory and motor block at 15 min was noted in Group A 45 patients (60%) and 25 patients (33.33%) in Group B (p=0.002*). At 60 min, there was no significant sensory unilaterality between the groups (p=0.987). At 60 min, 30 patients (40%) in Group A and 14 patients (18.66%) in Group B had strict unilateral motor block (p=0.007*). Highest achieved sensory level on nondependent side was T10 in Group A and T8 in Group B, whereas it was T6 in Group A and T5 in Group B on dependent side. Conclusion: For unilateral spinal anesthesia, spinal flexion position provided better strict unilaterality and restricted sympathetic blockade than spinal extension position.

Frequency of Post Dural Puncture Headache with Median Versus Para-Median Approach of Spinal Anaesthesia in Patients Underwent Cesarean Section

Objective: To compare the frequency of post dural puncture headache with median versus para-median approach of spinal anaesthesia in females undergoing cesarean section. Study Design: Comparative cross-sectional study. Place and Duration of Study: Anesthesiology and Obstetric departments, Combined Military Hospital, Badin Pakistan, from Oct 2018 to Apr 2019. Methodology: Total 128 females undergoing cesarean section, fulfilling the inclusion criteria were included randomly in two equal groups. Group-A received spinal anaesthesia with 25 G Quincke spinal needle by median approach while Group-B received by paramedian approach. Post-dural puncture headache was assessed by using visual analogue scale. Pain of any severity was taken as positive. All patients were followed by researcher for presence or absence of post-dural puncture headache. Results: Post dural puncture headache occurred in 21(32.81%) patients with median approach versus 4(6.25%) patients complained headache after para-median approach with p-value=0.0001, frequency was statistically significant. Conclusion: This study concluded that more frequency of headache after dural puncture in median approach compared to para-median approach in cesarean section patients.

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.

EFFECT OF INTRAVENOUS ONDANSETRON PREMEDICATION ON SPINAL ANESTHESIA INDUCED HYPOTENSION IN CESAREAN SECTION - A RANDOMIZED CONTROLLED STUDY.

Background:- Spinal anesthesia is the most common anaesthesia technique for cesarean section. In this technique injection of a local anesthetic agent is injected into the subarachnoid space. The most common complication of spinal anesthesia is hypotension which is due to sympathetic blockade and activation of the Bezold Jarisch reex which leads to the utilization of higher doses of vasopressors for the maintenance of blood pressure. The present study was conducted to compare the effect of intravenous ondansetron premedication on spinal anesthesia-induced hypotension with normal saline. An observa methodology:- tional study was conducted in 180 term parturients of ASA - ІІ, scheduled for elective LSCS under spinal anesthesia. The patients were divided into two equal age groups: ondansetron 4mg (group O, n= 90) and saline group (group S, n= 90). Ondansetron 4mg (2ml) was given 10 min before the procedure in group O and group S received 2ml normal saline. Under all aseptic precautions, subarachnoid space was accessed through L3-L4 or L4-L5 intervertebral space using 25G Quincke's spinal needle. After conrmation of the free ow of CSF, a 2ml hyperbaric injection of bupivacaine 0.5% (Heavy) was administered in the subarachnoid space. Mean arterial pressure less than 65mmHg was considered as hypotension and treated with iv mephentermine 6mg bolus. The Occurrence of hypotension in Group O (22.22%) was signicantly l Result- ower than in group S(61.11%)(p<0.001). The MAP was signicantly higher in Group O at 2,4,6,8,10,12,14,16,20 and 25 minutes (p<0.005). 18 (20%) patients required one dose of mephentermine 6mg, and 2(2.22%) patients required two doses in group O. In group S 40 patients ((44.44%) required one dose of mephentermine 10 patients ((11.11%) ) required two doses and 5 patients (5.55%) required 3 doses. In group O 3 patients (3.33%) and in group S, 12 patients (13.33%) had nausea which was statistically signicant with a P value of 0.01. In group S 12 patients (13.33%) and 4 patients (4.44%) in group O had shivering. Which was statistically signicant with a P value of 0.03. Ondansetron is effective in Conclusion – preventing spinal-induced hypotension in elective cesarean section

EFFECT OF PREVIOUS SCORPION BITE ON THE EFFICACY OF INTRATHECALLY ADMINISTERED LEVOBUPIVACAINE IN SUBARACHNOID BLOCK

Objectives: Local anesthetics administered by spinal anesthesia acts through sodium channels. Mutations of sodium channels may be responsible for resistance to local anesthetic agents. The scorpion venom contains neurotoxins that block the sodium channels. In view of the high prevalence of scorpion stings in our region and observation of failure of spinal anesthesia in patients with a history of scorpion stings in routine practice, the present study is planned. Methods: Forty patients of the American Society of Anesthesiologists Grade I or II who were undergoing infraumbilical surgery were divided into two groups as S (patients with h/o scorpion bite) and C (patients with no such history). The subarachnoid block was given with 3.2 ml of injection Levobupivacaine 0.5% heavy using 26 gauzes Quincke spinal needle. A blind observer recorded a sensory block using a needle prick and a motor block using the Bromage scale. Onset of sensory and motorized block, time to peak of sensory, and motor block and its relation to number of scorpion bites were observed in both the groups. Results: The onset of sensory (2.61±1.68 mins) and motor blockade (2.91±1.80 mins) was significantly delayed in Group S (p=0.010 and 0.004, respectively). Time to peak of sensory and motor blockade was also prolonged in Group S (6.45±2.83 mins and 7.8±3.95 mins) compared to Group C (3.60±0.84 mins and 4.56±1.30 mins) which was statistically significant (p<0.05). Patients who had previous scorpion bites (Group S) had a significant failure rate of spinal anesthesia compared to the control group. Conclusion: In this study, it was observed that the patients with scorpion bites had a significant failure rate of spinal anesthesia, suggesting probable resistance to the local anesthetic agents.

Measurement of the Outcome of Low Dose of 0.5% Bupivacaine Heavy in Spinal Anesthesia during Lower Segment Cesarean Section (LSCS)


 Background: Spinal anesthesia for lower segment cesarean sections is not without its challenges for anesthesiologists, such as severe hypotension from too much bupivacaine or insufficient anesthetic from too little.
 Objective: In this study our main goal is to measure the efficacy of low dose of 0.5% Bupivacaine in spinal anesthesia during lower segment cesarean section.
 Methods: This investigation was conducted at a tertiary medical institution as a cross-sectional comparison study between January 2020 and January 2021, where one hundred pregnant ladies participated.
 Patients who volunteered to take part in the trial were randomly split into two groups: Group A got an intrathecal injection of 3 mL of bupivacaine 0.5% (n=50), while Group B received an intrathecal injection of 2.5 mL of bupivacaine 0.5% (n=50). Tossing a coin was used as a randomizer. The patient's heart rate, blood pressure, and oxygen saturation were taken before receiving anesthesia. Each patient underwent a subarachnoid block (SAB) using a 25-gauge Quincke spinal needle using a midline route after being preloaded with 800 ml to 1000 ml of isotonic intravenous fluid. The entire process of injecting the hyperbaric bupivacaine took no more than twenty to thirty seconds.
 The needle's bevel was aligned with the dura's fibers. All of the data was entered into SPSS-25 after being coded. Statisticians used both descriptive and inferential methods. Percentages, means, standard deviations, graphs, tables, figures, and inferential statistics were all part of the descriptive statistics.
 Results: Most participants were between the ages of 26 and 33, and between 60% and 70% were multiparous over the course of the research.
 In both groups, all patients were able to reach a suitable sensory level for surgical intervention, as shown below. However, ephedrine was advised for 89% of Group B patients to help stabilize their blood pressure, whereas only 19% of Group A patients needed ephedrine. There were no significant variations in fluid consumption (P > 0.05) between Groups A and C (894 126 mL vs. 720 212 mL). The newborn's Apgar score was 9 at 1 minutes and 10 at 5 minutes. Also, although 19% of people in group A reported feeling sick, 23% of people in group B did.
 Conclusion: A lower segment cesarean section performed under an optimal dose of hyperbaric bupivacaine in the spinal anesthesia will produce excellent surgical conditions with little hypotension, in contrast to the low dose. Improved results require more research..

Comparative Study on the Effects and Complications of Transverse Insertion of Two Fine Gauge Quincke's Spinal Needles 26 and 29 G in Spinal Anesthesia

Introduction: Spinal anesthesia is one of the most commonly used techniques in modern anesthesia. Spinal needles have evolved over time to increase efficacy and decrease complications. Fine gauge spinal needles technically consume more time but are advisable in certain clinical conditions such as raised intracranial pressure and when patient well-being and comfort are the priorities. Hence, we undertook this study to compare the effects and complication of transverse insertion of Quincke's spinal needle 26 G (gauge) and 29 G. Materials and Methods: Hundred patients of age 18–40 years posted for lower abdominal and lower limb surgeries were allocated into two groups of 50 each to receive spinal anesthesia with 3 ml of 0.5% bupivacaine using 26 G or 29 G Quincke's spinal needle. All the patients were evaluated for the time of drug administration, number of attempts, time to attain sensory blockade up to T8 level, time to attain motor blockade up to bromage Grade 3, and incidence of post-dural puncture headache (PDPH) and post-dural puncture backache. Results: Demographic data were comparable in both groups. The PDPH incidence on 3rd day for 29 G Quincke's was 0% while for 26 G Quincke's was 12%. There was statistically significant difference when 26 G Quincke's was compared with 29 G Quincke's for number of attempts, time of drug administration, time to attain motor and sensory block. Conclusion: 29 G Quincke's spinal could be used to provide spinal anesthesia in young adult patients owing to adequate sensory and motor blockade with no incidence of PDPH and backache.

Evaluation of non-modifiable factors associated with post-dural puncture headache following subarachnoid block utilising 26 G quincke spinal needle: Prospective, observational study

Background and Aims: Post-dural puncture headache (PDPH) is one of the complications of the subarachnoid block (SAB), and the incidence of PDPH is influenced by various factors related to either patients or the type of spinal needle used. This study observed the incidence and severity of PDPH in relation to non-modifiable factors in the patients scheduled for surgeries under SAB. Methods: The study enrolled 302 obstetric and non-obstetric patients, aged 20–60 years, American Society of Anesthesiologists (ASA) I/II having body mass index (BMI) 18.5–29.9 kg.m-2 scheduled for surgeries under SAB utilizing 26 G Quincke spinal needle. Primary outcome was the incidence of PDPH in obstetric and non-obstetric patients. The secondary outcomes included onset, severity of PDPH, and association of age, BMI, and gender to PDPH. Results: The total incidence of PDPH was 5.6%, eight (7%) patients in obstetric and nine (4.8%) patients in non-obstetric group (P = 0.597). The onset of PDPH was comparable in obstetric 17.25 ± 3.69 and non-obstetric patients 18.0 ± 6.02 h (P = 0.663). None of the patient had severe PDPH. The BMI of the patients was not associated with the incidence of PDPH. The female patients among non-obstetric group had higher incidence of PDPH (P = 0.0002). The six patients having PDPH in non-obstetric group belonged to age-group of 31–40 yrs as compared to two above 40 years (P = 0.0173). Conclusion: Obstetric population had comparable incidence of PDPH to non-obstetric population. In the subgroup analysis of non-obstetric patients, the higher incidence of PDPH was observed in the female and younger patients.

Abstract No.: ABS3215: Superior trunk block: An unorthodox alternative to interscalene block for proximal humerus surgeries in patients with significant pulmonary disease

Background and Aims:Proximal shoulder surgery in patients with compromised pulmonary function stipulated the utilisation of superior trunk block, which spares phrenic nerve,as an alternative to interscalene block. This modificationallows patients to execute normal respiration perioperatively.This case series reports the efficacy of the block.Methods:Eight patients aged between 40 years to 80 years with significant restrictive, obstructive pulmonary disease and post-COVID 19 sequelae, posted for proximal humerus surgeries received the block. The block was performed under ultrasound guidance using 23 gauge Quincke spinal needle with 1:1 local anaesthetic mixture of 2% lignocaine+adrenaline and 0.5% bupivacaine with total volume injected being 15ml. The outcomes measured were loss of shoulder abduction, numbness of shoulder and pain relief, numbness of arm ,sonographic assessment of diaphragm movement, oxygen saturation perioperatively and closed-circuit measurement of the tidal volume generated.Results:Seven patients with superior trunk block achieved complete surgical anaesthesia of proximal shoulder. There was solitary use of dexmedetomidine for a patient with severe anxiety. Two patients required oxygen supplementation throughout the intraoperative period extending to post-operative period as well. Sonographic assessment intraoperatively and post-operatively disclosed adequate diaphragmatic excursion in all patients (table 1). Post-operative pain scores revealed satisfactory pain relief.Table 1Description of clinical variables in the case seriesCaseAnaesthesia of shoulder and upper armOxygen saturationTidal volume Diaphragmatic movementRescue analgesia 1Yes94%420 mlAdequateNo2Yes93%445 mlAdequateNo3Yes92%430 mlAdequateNo4Yes93%400 mlAdequateNo5Yes90%415 mlAdequateNo6Yes88%370 mlAdequateNo7Partial89%380 mlAdequateYes8Yes92%460 mlAdequateNoConclusion:Effective surgical anaesthesia and analgesia is delivered considerably with superior trunk block for surgeries of proximal humerus in patients with compromised pulmonary function by sparing phrenic nerve and is an appropriate substitute for interscalene block.

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.

Haemodynamic Effects and Quality of Intrathecal Block in Lateral Decubitus Position using 25G Whitacre versus 25G Quincke Spinal Needles- A Cohort Study

Introduction: Various attempts have been made to manipulate the needle designs to counter the adverse effects (hypotension, postdural puncture headache) of spinal anaesthesia. This includes the modification of the tip, the location of the orifice, and the length and material of the needle. Aim: To access if a Whitacre needle is a better substitute than the classical commonly used, Quincke spinal needle along with intraoperative haemodynamic changes and quality of intrathecal block. Materials and Methods: The present stud was a hospital-based cohort study which included 100 patients in the age group of 20-50 years, who belonged to American Society of Anaesthesiologists (ASA) Grade of I and II, and were operated on for lower abdominal and lower limb surgeries under spinal anaesthesia. They were assigned into two groups A and B, wherein group A, 25G Whitacre and in Group B, 25G Quincke needles were used respectively. The primary outcome measures were the differences in the incidence of hypotension, bradycardia, and quality of sensory and motor blockade in the two groups. The t-test and Chi-square test were used. Statistical calculations were done using Statistical Package for the Social Science (SPSS) 21.0 version. Results: There was a noteworthy drop in the blood pressures (Systolic blood pressure (SBP), Diastolic blood pressure (DBP), Mean Arterial Pressure (MAP), where the readings were - group A 117.59 mmHg, group B 117.39 mmHg, group A 73.58 mmHg, group B 73.15 mmHg, group A 88.25 mmHg, group B 87.90 mmHg. But the variance between the two needle groups was statistically insignificant (p>0.05). There was no statistically significant difference between the two needles group to the quality of intrathecal block. Sensory block onset in group A (83.08±12.26 seconds), group B (81.42±17.81 seconds) with p-value 0.410. The mean bromage score in group A (2.90±0.30), group B (2.88±0.33). Conclusion: Both the needles provided excellent sensory and motor blockade and haemodynamic steadiness.

Incidence and Risk Factors of "Postdural Puncture Headache" in Women Undergoing Cesarean Delivery under Spinal Anesthesia with 26G Quincke Spinal Needle, Experience of Medical College in Rural Settings in India 2019: A Prospective Cohort Study Design.

Introduction:Almost every cesarean delivery is done under spinal anesthesia because of ease of doing, rapid onset, avoids maternal and fetal risk of general anesthesia, promotes early recovery. Major complication especially in young women undergoing LSCS under spinal anesthesia is post dural puncture headache (PDPH) which is caused by cerebrospinal fluid leakage. There is wide variation in reported incidence of PDPH (0.3% to 40 %) after spinal anesthesia being affected by various procedure and non procedure related risk factors like age, gender, needle size and type, numbers of spinal attempts and previous history of PDPH.Methods:Prospective cohort study was conducted in 335 patients posted for caesarean section under spinal anesthesia from January 2019 to September 2019 in medical College situated in rural India. Spinal anesthesia was given by 26 G Quincke spinal needle. All patients were evaluated for incidence and severity of PDPH from post operative day 1 to day 5.Result:Incidence of PDPH was 11.4% in this study. Majority of patients (62.5%) were having mild pain. All patients reported PDPH with 72 hours.Conclusion:Body mass index (BMI), h/o PDPH, multiple attempts for successful spinal anesthesia did not have any significant association with PDPH in our study.

Comparative study between the effect of intrathecal bupivacaine versus bupivacaine dexmedetomidine combination in spinal anaeshtesia for lower abdominal surgeries

Abstract Study objectives We compared effect of intrathecal bupivacaine versus bupivacaine Design This is a prospective, randomized, double-blinded study. Setting The setting is at an operating room in Ain Shams University Hospital. Patients: 50 patients scheduled for general anesthesia were randomly allocated to the following 2 groups in equal numbers. Interventions Spinal anaesthesia will be performed in the sitting position at L3-L4 or L4-L5 level using a 25-gauge Quincke spinal needle by the most competent experts. The sensory block level will be assessed along the mid-clavicular line bilaterally. The motor block will be assessed according to Bromage scale Measurements Post operative (VAS) score and Time to first requested analgesia.(primary outcome), Systolic blood pressure, diastolic blood pressure, mean blood pressure and heart rate will be recorded every 5 minutes for 20 minutes then every 15 minutes till the end of surgery, Nausea and/ or vomiting as yes/no, Level of highest sensory block, Bromage score ≥3, Onset of sensory block and Two segment regression time (secondary outcomes) were recorded.. Main results Results of this study showed that the addition of dexmedetomidine to bupivacaine in spinal anaesthesia significantly prolonged both sensory and motor blockades duration compared with bupivacaine alone. They also prolonged the time of postoperative analgesia as evidenced by significantly longer time to first rescue analgesia and lower NRS scores with minimal adverse effects and haemodynamic stability. Conclusions We concluded that intrathecal dexmedetomidine increases the duration of analgesia and reduces postoperative pain without changes in the hemodynamic parameters and adverse side effects. It can be considered as an appropriate adjuvant to intrathecal local anesthetics for lower abdominal surgeries.