Post-dural puncture headache in young adults: comparison of two small-gauge spinal catheters with different needle design

Background. To reduce the risk of post-dural puncture headache(PDPH) in continuous spinal anaesthesia, small-gauge spinalcatheter systems with different techniques of dural perforationhave been developed. Methods. Two systems, the catheter through-needle technique(MicroCatheter, Portex, UK) and the catheter over-needle technique(22G Spinocath®, B. Braun, Germany), were used in 18 younghealthy volunteers (age 18–30 yr), who were enrolled ina neuroendocrinological investigation for analysis of neuropeptidesin cerebrospinal fluid (CSF). After intermittent sampling ofCSF (17x0.5 ml over 4 h), the catheter was removed and the developmentof PDPH and pain intensity were documented prospectively bythe subjects in a standardized headache assessment (11-pointnumerical rating scale [NRS]). Results. The study revealed a high overall incidence of PDPH(78%) with no significant differences between groups (P=0.26).However, the over-needle group showed a significantly shorterduration of PDPH (2.4 [SD 2.3] vs 5.1 [3.1] days, P=0.050) andlower maximum pain intensity (3.1 [2.9] vs 7.3 [3.4] NRS, P=0.014)than the through-needle group. Conclusions. The results demonstrate a potential benefit ofthe catheter over-needle technique for the reduction of theduration and intensity of PDPH.     

Blood patch for spinal headache

The management of a patient is described who has a blood patch for spinal headache, but who had a recurrence of symptoms 1 day later which was successfully treated by a second patch. A second case is described in which there was a second dural puncture immediately prior to the blood patch and, immediately following the blood patch, the patient complained of severe debilitating 'paralysing' pain in both legs. This pain was of short duration and the blood patch was successful. Some further observations on the use of a blood patch are recorded.     

Strength of continuous spinal catheters.

Several commercially available catheters are currently marketed for continuous intrathecal use. Initial studies using continuous spinal catheters have reported several occurrences of retained fragments after removal of the catheter. Accordingly, we measured the break strength of five commercially available catheters. The TFX/Rusch 28- and 32-gauge continuous spinal catheters required 3.18 and 1.92 lb to break, respectively. The Kendall 28-gauge, the Preferred Medical Products 24-gauge, and the 24-gauge Burron catheters averaged 1.22, 1.97, and 3.55 lb to break, respectively. We also tested a commonly used Burron 20-gauge catheter, which is marketed for epidural use, and found it had an average break strength of 6.35 lb. The tested values obtained for the TFX/Rusch catheters were lower than the break strength values supplied by the manufacturers. The authors conclude that the break strength of spinal catheters is one-third to one-half that found for a typical epidural catheter.     

Beyond spinal headache: prophylaxis and treatment of low-pressure headache syndromes

OBJECTIVE: This Evidence-Based Case Management article evaluates and grades the evidence for two anesthesiology-related interventions: prophylaxis after unintentional meningeal puncture and treatment of spontaneous intracranial hypotension (SIH). METHODS: A search was made of relevant English language clinical studies or reports pertinent to the topic of low-pressure headache, but excluding the treatment of meningeal puncture headache. RESULTS: Thirty-seven case reports, case series, and clinical trials were included to develop the best available evidence-based recommendations for the prophylaxis of unintentional meningeal puncture and for the treatment of SIH. CONCLUSION: The highest quality randomized controlled trials suggest that prophylactic epidural blood patch (EBP) does not reduce the incidence of headache after unintentional meningeal puncture. The weight of existing literature supports EBP as an initial treatment of SIH, although its effectiveness does not approach that seen when EBP is used to treat meningeal puncture headache.     

Evaluation of intravenous hydrocortisone in reducing headache after spinal anesthesia: a double blind controlled clinical study [corrected

BACKGROUND: Headache after spinal anesthesia is a common complication is patients undergoing this procedure. In this study we evaluated the efficacy of intravenous hydrocortisone in the treatment of headache after spinal anesthesia in women who have undergone cesarean section. METHODS: Sixty patients with headache after spinal anesthesia were included. Patients randomly allocated into two groups, 30 patients received only conventional therapy (complete bed rest, hydration, acetaminophen and pethidine). Other 30 patients received conventional therapy plus intravenous hydrocortisone (200 mg first, then 100 mg TID for 48 hours). Mean (+/- SD) of headache intensity at 0, 6, 24, and 48 hours after beginning of treatment was measured using visual analog scale. RESULTS: There was no significant difference in headache intensity between two groups before beginning of treatment. After 6 hours, the mean of headache intensity in 30 patients treated conventionally was 6.63 (+/- 1.35) while it was 2.77 (+/- 1.07) in other patients received intravenous hydrocortisone too (p <0.001). After 24 hours, mean headache intensity was 3.87 (+/- 1.63) in conventionally treated group versus 0.73 (+/- 0.74) in hydrocortisone group (p <0.001). After 48 hours, mean headache intensity was 1.87 (+/- 0.93) in conventionally treated group versus 0.63 (+/- 0.61) in hydrocortisone group (p = 0.001). CONCLUSIONS: This study showed the therapeutic effects of intravenous hydrocortisone in reducing headache after spinal anesthesia in women who underwent cesarean section. Its mechanism of action is yet to be determined.     

减少脊柱手术术中出血措施的研究进展

<正>脊柱外科手术常伴随着大量失血的风险,术中大量失血可以造成患者血流动力学不稳定,增加手术并发症,甚至危及生命,因此常需要补充足够的异体血液来维持血容量、纠正贫血。然而,大量的异体输血会增加免疫性及传染性疾病发生的风险,部分受血者可能发生输血相关性肺损伤、肾功能衰竭、心肌梗死等严重输血反应,甚至危及生命[1、2]。如何控制术中血液的丢失已成为脊柱外科手术中管理策略的焦点之一。有效减少术中出血不但能够保障患者     

Failure of repeated blood patch in a parturient with spinal headache

An obstetric patient, who received and accidental dural puncture, developed symptoms that persisted until the administration of a third epidural blood patch. Her management is presented. The possible causes of failure of this technique are discussed, with specific reference to the obstetric patient. The role of cerebrospinal fluid in the epidural space at the time of patching is considered.     

The mechanical properties of continuous spinal small-bore catheters

Continuous spinal anesthesia (CSA) has a nearly 100-yr history. In situations of difficult removal of a CSA small-bore catheter, mechanical properties of the different catheters might be important, because breakage could occur. We compared 5 different CSA small-bore catheters, 22- to 28-gauge from 3 manufacturers, for tensile strength, tensile stress, distension, and yield strength. Maximal tensile strength is the force applied before breakage of the catheter. The material characteristics of different CSA small-bore catheters for maximal tensile strength were: 22-gauge = 29.56 +/- 1.56 (mean +/- sd) Newton (N), 24-gauge = 16.77 +/- 1.61 N, 25-gauge = 9.20 +/- 0.48 N, 27-gauge = 4.61 +/- 0.25 N, 28-gauge = 5.07 +/- 0.59 N at room temperature. A strong correlation between maximal tensile strength and the outer diameter (r = 0.957, P < 0.001) and maximal tensile strength and the wall thickness (r = 0.9, P < 0.001) was observed. Although extrapolation from experimental studies to clinical routine should be made with care, our data suggest that catheters with higher-strength characteristics may reduce the risk of catheter breakage in patients, although clinical correlations are lacking.     

32-gauge spinal catheters through 26-gauge needles

Small diameter intrathecal catheters potentially combine the certainty of intrathecal injection and the advantage of repeatability, without the risk of a high incidence of headache after dural puncture. We report problems placing such catheters.     

Prevention of headache from spinal anesthesia with the use of epidural cortisone

The Authors have analysed the etiopathogenetic factors of the post-dural puncture headache. To prevent this complication they have experimented an original method: in 74 patients they have injected 1.5 mg of betamethasone (diluted in physiological solution) into the epidural space after the anaesthetic infusion. They conclude supporting the validity of this method of prevention and its safety.     

Postoperative headache in young patients after spinal anaesthesia

Spinal anaesthesia was performed on 247 young adult patients with a 25-G needle. Rectal administration of indomethacin had no significant effect on the incidence of postdural puncture headache, which occurred in 16.8% of patients who received the drug compared to 24.5% who received a placebo. A history of headache pre-operatively did not influence the incidence of postlumbar puncture headache.