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.
RCT Entities:
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.
Authors: Ingrid Arevalo-Rodriguez; Luis Muñoz; Natalia Godoy-Casasbuenas; Agustín Ciapponi; Jimmy J Arevalo; Sabine Boogaard; Marta Roqué I Figuls Journal: Cochrane Database Syst Rev Date: 2017-04-07
Authors: Sebastiaan Engelborghs; Ellis Niemantsverdriet; Hanne Struyfs; Kaj Blennow; Raf Brouns; Manuel Comabella; Irena Dujmovic; Wiesje van der Flier; Lutz Frölich; Daniela Galimberti; Sharmilee Gnanapavan; Bernhard Hemmer; Erik Hoff; Jakub Hort; Ellen Iacobaeus; Martin Ingelsson; Frank Jan de Jong; Michael Jonsson; Michael Khalil; Jens Kuhle; Alberto Lleó; Alexandre de Mendonça; José Luis Molinuevo; Guy Nagels; Claire Paquet; Lucilla Parnetti; Gerwin Roks; Pedro Rosa-Neto; Philip Scheltens; Constance Skårsgard; Erik Stomrud; Hayrettin Tumani; Pieter Jelle Visser; Anders Wallin; Bengt Winblad; Henrik Zetterberg; Flora Duits; Charlotte E Teunissen Journal: Alzheimers Dement (Amst) Date: 2017-05-18