OBJECTIVE: To determine the incidence of paresthesia with different spinal puncture techniques using a 27-gauge Whitacre needle. MATERIAL AND METHODS:Spinal puncture was performed in 224 elective cesarean sections using different techniques in this single-blind, prospective trial. Patients were randomized to 4 groups: group 1, combined epidural and subarachnoid puncture using an introducer needle; group 2, combined epidural and subarachnoid puncture without an introducer; group 3, subarachnoid puncture with an introducer; and group 4, subarachnoid puncture with an introducer to within a few millimeters of the dural sac, at which point the introducer was withdrawn. RESULTS:Paresthesia developed in 23, 11, 16 and 5 patients in groups 1, 2, 3 and 4, respectively. Various nerve roots were affected. In 2 and 11 cases the fourth and fifth lumbar nerve roots were affected; in 29 and 13 cases, the first and second sacral nerve roots were involved. In comparison with group 4, the risk of paresthesia was 7, 2.5 and 4 times greater in groups 1, 2 and 3, respectively. CONCLUSIONS: Combined epidural-subarachnoid puncture leads to a higher incidence of paresthesia in comparison with simple spinal puncture, probably because the lumbar puncture is performed on a dural sac that has been previously deformed due to the "tent effect" caused by the epidural needle. Fewer cases of paresthesia occur when the subarachnoid puncture is slow and steady and the introducer needle is withdrawn millimeters before it reaches the dural sac.
RCT Entities:
OBJECTIVE: To determine the incidence of paresthesia with different spinal puncture techniques using a 27-gauge Whitacre needle. MATERIAL AND METHODS: Spinal puncture was performed in 224 elective cesarean sections using different techniques in this single-blind, prospective trial. Patients were randomized to 4 groups: group 1, combined epidural and subarachnoid puncture using an introducer needle; group 2, combined epidural and subarachnoid puncture without an introducer; group 3, subarachnoid puncture with an introducer; and group 4, subarachnoid puncture with an introducer to within a few millimeters of the dural sac, at which point the introducer was withdrawn. RESULTS: Paresthesia developed in 23, 11, 16 and 5 patients in groups 1, 2, 3 and 4, respectively. Various nerve roots were affected. In 2 and 11 cases the fourth and fifth lumbar nerve roots were affected; in 29 and 13 cases, the first and second sacral nerve roots were involved. In comparison with group 4, the risk of paresthesia was 7, 2.5 and 4 times greater in groups 1, 2 and 3, respectively. CONCLUSIONS: Combined epidural-subarachnoid puncture leads to a higher incidence of paresthesia in comparison with simple spinal puncture, probably because the lumbar puncture is performed on a dural sac that has been previously deformed due to the "tent effect" caused by the epidural needle. Fewer cases of paresthesia occur when the subarachnoid puncture is slow and steady and the introducer needle is withdrawn millimeters before it reaches the dural sac.