Subramaniya Bharathiyar, R (2010) Incidence of Postdural Puncture Headache in Caesarian Section a Comparison between 25 Gauge Quincke and 25 Gauge Pencil Point Spinal Needles. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: The history of anaesthesiology is a rich mosaic of interwoven events around the world that have created and defined the specialty. From the days of the ancient Greeks and Romans to the modern operating rooms, the care of the patients remain challenging. With the introduction of general anesthesia in 1846 to the development of regional techniques, anaesthesia has been a evolving specialty. The complications of general anaesthesia led to the discovery of regional anaesthesia. Spinal anesthesia developed in late 1800s with the work of Wynter, Quincke and Corning. The term “ spinal anaesthesia” was coined by Leonard Corning in 1885. Later in 1898, Karl August Bier injected 10 – 15 mg cocaine into subarachanoid space of seven patients, himself and his assistant Hildebrandt. Bier, Hildebrandt and four of the patients described symptoms associated with postdural puncture headache (PDPH). Bier was first to describe postdural puncture headache and attributed this headache to excessive loss of cerebro spinal fluid. It has been over one hundred years since Dr. Bier experienced and wrote about the first reported postdural puncture headache. The incidence of PDPH was as high as 66% with large gauge medium bevel cutting needles, which reduced to 3-25% with 25 gauge cutting needles which further reduced to 0-14% with 25 gauge pencil point needles. Thus, in the last 50 years with the development of fine gauge needles and needle tip modification, there is a significant reduction in the incidence of postdural puncture headache. The incidence of PDPH is high in obstetric population because of their young age, sex and wide spread use of central neuroaxial blocks. PDPH is the third most common reason for litigation in obstetric anaesthesia. Despite obvious advantages of regional over general anaesthesia for obstetrics, regional techniques was not popularized. The period from 1930 to 1950 has often been referred to “dark ages of obstetric anaesthesia”. In 1951, after the development of pencil point spinal needles by Whitacre and Hart, and changes in needle tip design, there was a significant reduction in incidence of postdural puncture headache. This randomized control study, was done in Government RSRM hospital, affiliated to Government Stanley Medical College, Chennai. The aim of the study is to compare the incidence of PDPH with 25 gauge Quincke and 25 gauge pencil point spinal needles in patients undergoing caesarian section under spinal anesthesia. AIM OF STUDY: To compare the incidence of postdural puncture headache with 25 gauge Quincke and 25 gauge pencil point spinal needles in patients undergoing caesarian section under spinal anesthesia. MATERIALS AND METHODS: Inclusion Criteria: 1. Patient age group 17 – 35 years. 2. Singelton uncomplicated pregnancy of gestational age > 32 weeks. 3. ASA 1, 2 patients. Exclusion Criteria: 1. Pregnancy induced hypertension. 2. Cardio vascular disorders. 3. Hypovolemia and shock. 4. Obesity. 5. Infection of the back. 6. Anticoagulant therapy. 7. Patients requiring more than one attempt. 8. Patients with history of migraine. MATERIALS: 1. 25 gauge Quincke and 25 gauge pencil point spinal needles. 2. 0.5% hyperbaric bupivacaine ampoules. 3. IV cannulae, monitors. 4. Drugs for general anaesthesia in case of inadequate block. 5. Emergency drugs. METHODS: 1. Patients were randomly divided into two groups by systematic randomization. 2. Group one : Patients who received spinal anaesthesia with 25G pencil point needle (study group). 3. Group two : Patients who received spinal anaesthesia with 25G Quincke needle (control group). 4. Written informed consent was obtained from all patients. 5. All techniques was done by third year postgraduate in Anaesthesiology. 6. Detailed history of present and past medical illness was obtained. 7. Routine urine and blood investigations were done. 8. General and systemic examinations were done. RESULTS: The study was conducted in Government RSRM Hospital, affiliated to Government Stanley medical college, Chennai. A random sample of 120 patients undergoing caesarian section under spinal anesthesia was selected from the population. Patients were randomized systematically by numbering them. All odd numbered patients were in the study (pencil point ) group and even numbered patients were in the control (Quincke) group. The continuous data was assessed by means and Standard Deviation (SD). The discrete data was assessed in number and percentage. Chi-square test and Fisher’s Exact test for determining the difference between groups. P value < 0.05 was considered statistically significant. SUMMARY: We studied the incidence of PDPH using two different spinal needles. Group one using 25 gauge non cutting (pencil point) spinal needle and group two using 25 gauge cutting spinal needle (Quincke) in patients under going elective or emergency caesarian section. There was no statistical significant differences between groups in demographic data. There was no significant difference in patients under going elective or emergency caesarian section between the two groups. There was statistically significant rate of decreased incidence of PDPH in the study group ( pencil point = 5%) compared to the control group (Quincke = 18.3% ). There was a statistically significant failure spinal anaesthesia in study group (pencil point = 16.7%) compared to the control group (Quincke = 3.3%). CONCLUSION: From this randomized control trial in 120 patients undergoing caesarian section, it was concluded that the incidence of PDPH was significantly low with 25 gauge non cutting bevel (pencil point = 5%) spinal needles compared with 25 gauge cutting bevel (Quincke = 18.3%) spinal needle. The incidence of failed spinal anaesthesia was significantly more in non cutting (pencil point= 16.7%) spinal needles than cutting (Quincke = 3.3%) spinal needles.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Postdural Puncture Headache ; Caesarian Section ; Comparison ; 25 Gauge Quincke ; 25 Gauge Pencil Point Spinal Needles. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 22 Apr 2018 16:16 |
| Last Modified: | 28 Apr 2018 16:38 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7252 |
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