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Correspondence |
1 Winston-Salem, North Carolina
2 Lexington, Kentucky
3 Richmond, Virginia
To the Editor:
The Atraucan (AT) dual-bevelled spinal needle, which has been shown, in vitro, to cause less cerebral spinal fluid (CSF) leakage than comparable Quincke, Sprotte and Whitacre (WH) spinal needles,1,2 has been available in the United States since 1993. Three clinical studies3–5 compared the success or complication rate of AT spinal needles to pencil-point spinal needles. Vallejo et al.5 reported a higher incidence of epidural blood patch and postdural puncture headache (PDPH) associated with 26-gauge AT spinal needles compared to 25-gauge WH needles. Sharma et al.3 and Andres et al.4 reported that the 26-gauge AT spinal needles were technically easier to use than WH 25-gauge or 27-gauge needles and the PDPH incidences were similar. Sharma further suggested larger studies to better define PDPH and failed spinal blockade rate associated with the AT needle. We, therefore, present here our comparisons of the incidence of PDPH, postdural puncture backache (PDPB) and the failed spinal blockade rate between AT and WH spinal needles.
After Institutional Review Board approval and informed consent, 215 ASA I–II patients undergoing postpartum tubal ligations were randomly assigned to receive subarachnoid anesthesia with either 26-gauge AT (B. Braun Medical, Bethlehem, PA, USA; OD - 0.45 mm, length - 8.89 cm) or 25-gauge WH (Becton-Dickinson, Rutherford, NJ, USA; OD - 0.5 mm, length - 8.89 cm) spinal needles. Spinal needles were introduced with the midline approach at the L2–3, L3–4, or L4–5 intervertebral space. The number of attempts to successful CSF return, success rate of the spinal blockade and the handling characteristics were documented intraoperatively. Postoperatively, an investigator blinded to group assignments interviewed patients daily while in the hospital and then via telephone seven to 14 days after discharge.
The results are summarized in the Table
. Incidence of PDPH was similar between AT (3.9%) and WH (4.0%) groups. The total duration of PDPH was five days and 15 days for AT and WH groups respectively, but the difference in duration between groups did not reach statistical significance. Both groups had a similar one-attempt success rate of 61% (AT) and 62% (WH). The average number of attempts to obtaining CSF were 1.5 ± 0.6 and 1.6 ± 0.7 for AT and WH groups respectively. Incidence of PDPB was 9.6% for AT and 9.0% for WH group; and the severity was mild in both groups. The incidence of failed spinal blockade was 7.7% and 7.0% for AT and WH groups respectively. Ninety-five percent of AT group and 93% of WH group would accept similar spinal anesthesia for future procedures.
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References
1
Holst D, Mollmann M, Ebel C, Hausman R, Wendt M. In vitro investigation of cerebrospinal fluid leakage after dural puncture with various spinal needles. Anesth Analg 1998; 87: 1331–5.
2 Morrison LM, McCrae AF, Foo I, Scott DB, Wildsmith JA. An in vitro comparison of fluid leakage after dural puncture with Atraucan, Sprotte, Whitacre, and Quincke needles. Reg Anesth 1996; 21: 139–43.
3
Sharma SK, Gambling DR, Joshi GP, Sidawi JE, Herrera ER. Comparison of 26-gauge Atraucan and 25- gauge Whitacre needles: insertion characteristics and complications. Can J Anaesth 1995; 42: 706–10.
4 De Andres J, Valia JC, Errando C, Rico G, Lopez-Alarcon MD. Subarachnoid anesthesia in young patients: a comparative analysis of two needle bevels. Reg Anesth Pain Med 1999; 24: 547–52.[Medline]
5
Vallejo MC, Mandell GL, Sabo DP, Ramanathan S. Postdural puncture headache: a randomized comparison of five spinal needles in obstetric patients. Anesth Analg 2000; 91: 916–20.
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