Abstract
Spinal anaesthesia provides rapid, safe anaesthesia for Caesarean section. The pencil-point spinal needles (Sprotte and Whitacre) are reported to have a low incidence of post-dural puncture headache (PDPH). As the 25G Whitacre is less expensive than the 24G Sprotte needle, this prospective, randomized, doubleblind study was designed to compare the incidence of PDPH and ease of insertion of these needles in 304 ASA 1 and 2 women having elective Caesarean section under spinal anaesthesia. Each patient was assessed daily for five consecutive days following Caesarean section by an investigator blinded to the needle used. The results indicate that the two needles have a similar ease of insertion, number of failed insertions, and failed subarachnoid blockade. An inability to insert the spinal needles occurred in two patients in each group. Therefore, 150 patients in each group completed the study. The incidence of PDPH with the 24G Sprotte needle was 4.0% (6/150) compared with 0.66% (1/150) with the 25G Whitacre (NS). There was no correlation between the occurrence of PDPH and the difficulty of needle insertion, presence of transient hypotension or the effectiveness of anaesthesia delivered. This study indicates that both needles are comparable with respect to ease of insertion and incidence of PDPH. As the Whitacre needle is less expensive it is a reasonable alternative to the more expensive Sprotte needle.
Résumé
La rachianesthésie administrée pour la césarienne offre les avantages d’une installation rapide et d’une grande sécurité. L’incidence de la céphalée post-rachidienne avec l’utilisation d’aiguilles à extrémité conique (Sprotte et Whitacre) est faible. Toutefois, l’aiguille Whitacre 25G coûte moins cher que la Sprotte 24G. Cette étude randomisée, prospective et à double insu vise à comparer pour ces deux aiguilles l’incidence de céphalée post-rachidienne et leur facilité d’insertion chez 304 parturientes ASA 1 et 2 programmées pour césarienne non urgente sous rachianesthésie. Après l’intervention, chaque patiente est évaluée pendant cinq jours consécutifs par un observateur ignorant du type d’aiguille utilisé. Les résultats montrent que les deux aiguilles s’introduisent avec la même facilité; la fréquence des insertions impossibles et des anesthésies ratées est la même pour les deux aiguilles. L’impossibilité d’insérer l’aiguille rachidienne survient deux fois dans chaque groupe. Cent cinquante patientes de chaque groupe ont donc pu compléter l’étude. L’incidence de céphalée post-rachidienne avec l’aiguille Sprotte 24G est de 4,0% (6/150) comparativement à 0,66% (1/150) avec la Whitacre 25G (NS). On ne trouve pas de corrélation entre la céphalée post-rachidienne et l’insertion difficile, l’hypotension transitoire ou la qualité de l’anesthésie. Cette étude montre que les deux aiguilles sont comparables au regard de la facilité d’insertion et de l’incidence de céphalée post-rachidienne. Le prix moins élevé de l’aiguille de Whitacre constitue un avantage sur l’aiguille Sprotte.
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This study was completed at the Grace Hospital, University of British Columbia, Vancouver, British Columbia.
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Campbell, D.C., Douglas, M.J., Pavy, T.J.G. et al. Comparison of the 25-gauge Whitacre with the 24-gauge Sprotte spinal needle for elective Caesarean section: cost implications. Can J Anaesth 40, 1131–1135 (1993). https://doi.org/10.1007/BF03009601
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DOI: https://doi.org/10.1007/BF03009601