Comparison of postanesthetic sequelae after clinical use of 27-gauge cutting and noncutting spinal needles.

Abstract

Background and objectives: The tips of the bevels of thin spinal needles may be easily damaged by bony contact during puncture attempts. In this respect and also because they are less traumatic by design, noncutting, pencil-point-tip needles may be beneficial. A prospective clinical comparison of postanesthetic effects of the use of 27G Quincke-type and pencil-point spinal needles was therefore performed.

Methods: The study included 400 spinal anesthesia patients, in 200 of whom the initial needle was a 27-gauge Quincke type, a 27-gauge pencil-point needle being used in the other 200. Altogether, 464 needles had to be used; in 30 cases the pencil-point needle was replaced by a 27- or 25-gauge Quincke-type needle. A block performance form was filled in, and the patients were interviewed personally on the first postoperative day and by means of a mailed questionnaire on the 14th day.

Results: The tips of the Quincke-type needles were distorted in a blunt, bent or hooked manner in 13% of the initial and 14% of the final needles. The severity of the damage was related to the count category of bony contacts during puncture (0, 1-4, or 5 or more). The occurrence of postdural puncture headache was not, however, related either to damage of the needles or to the number of puncture attempts. Diffuse (not posture-dependent) headache occurred more often after the use of the Quincke-type needle than after use of the pencil-point needles, the tips of which remained intact in each case.

Conclusion: Postanesthetic sequelae, including postdural puncture headache (overall incidence 2.5%), were not related to the shape of the spinal needles or to the damage of the Quincke-type needles.