Is there a difference in postdural puncture headache after continuous spinal anesthesia with 28G microcatheters compared with punctures with 22G Quincke or Sprotte spinal needles?

Postdural Puncture Headache Related to Procedure: Incidence and Risk Factors After Neuraxial Anesthesia and Spinal Procedures

OBJECTIVE

Postdural puncture headache (PDPH) is a potential complication of certain neuraxial anesthesia and spinal procedures, and some risk factors for PDPH have been identified. However, there have been no detailed analyses of rates and risk factors of PDPH after various spinal and neuraxial anesthesia procedures.

METHODS

Patient data from January 1, 2015, to December 31, 2017, were retrospectively analyzed. The patients underwent dural puncture procedures (spinal anesthesia, lumbar puncture [spinal tap], lumbar cerebrospinal fluid [CSF] drainage) or nondural puncture procedures (transforaminal epidural injection, interlaminar epidural injection, epidural catheterization with patient-controlled analgesia for delivery). PDPH incidence and risk factors were evaluated.

RESULTS

For dural puncture procedures, PDPH incidence was 2.96%, and risk factors were younger age, female sex, and lumbar puncture. Larger needle gauge was a risk factor according to Student t-test but not during logistic regression analysis. PDPH incidence was higher after lumbar puncture using a 22 G Tuohy needle (4.63%) than after lumbar CSF drainage using an 18 G Tuohy needle (3.05%). For nondural puncture procedures, PDPH incidence was 0.53% and did not differ between procedure types; no risk factors were identified.

CONCLUSIONS

PDPH incidence and risk factors depended on the type of neuraxial anesthesia and spinal procedures. PDPH incidence after lumbar puncture using a 22 G Tuohy needle was higher than that after lumbar CSF drainage using an 18 G Tuohy needle, suggesting that catheter insertion may reduce PDPH risk. In non-dural puncture procedures, PDPH risk did not differ according to type of procedure, and no risk factors were found.

Biomechanical Properties of the Cranial Dura Mater with Puncture Defects : An In Vitro Study

Objective

The primary aim of this investigation was to explore the nature of dura mater biomechanics following the introduction of puncture defect(s).

Methods

Twenty-eight dura mater specimens were collected during autopsy from the department of forensic medicine of the authors' institution. Specimens were divided randomly into one of four groups : group I (cranial dura mater; n=7), group II (cranial dura mater with one puncture defect; n=7); group III (cranial dura mater with two puncture defects; n=7), and group IV (cranial dura mater with three puncture defects; n=7).

Results

The mean±standard deviation tensile strengths of the dura mater were 8.35±3.16, 8.22±3.32, 7.13±1.77, and 6.94±1.93 MPa for groups I, II, III, and IV, respectively. There was no statistical difference between all groups. A single, two or more punctures of the dura mater using a 20-gauge Quincke needle did not affect cranial dura tensile strength.

Conclusion

This biomechanical study may contribute to the future development of artificial dura mater substitutes and medical needles that have a lower negative impact on the biomechanical properties of dura mater.

Continuous spinal analgesia with levobupivacaine for postoperative pain management: Comparison of 0.125% versus 0.0625% in elective total knee and hip replacement: A double-blind randomized study

Background and Aims:

Continuous spinal anesthesia (CSA) has not been widely used for postoperative analgesia, mainly to avoid complications from the subarachnoid injection. Recently, the introduction of low caliber CSA catheters (Spinocath^®), has allowed to decrease anesthetics doses and volumes with good analgesia and reduced complications. The aim of this present study was to compare two concentrations of levobupivacaine administered through CSA for postoperative pain management after major orthopedic surgery. Secondary outcomes were adverse events associated with CSA.

Material and Methods:

Thirty-two patients were randomized to receive sufentanil 1 mcg/h plus levobupivacaine 0.125%-1 ml/h (Group A_0.125) or 0.0625%-2 ml/h (Group B_0.0625) for postoperative analgesia through CSA catheter, connected to the elastomeric pump over 48 h. The quality of analgesia was assessed based on pain intensity by Visual Analogic Scale (VAS). Sensory and motor function, hemodynamic, and respiratory parameters were recorded for 96 h after surgery, after which the catheter was removed. In addition, joint mobility was assessed, and any side effects were noted.

Results:

VAS score was ≤30 mm in 25 patients. Three patients in Group A_0.125 and 4 in Group B_0.0625 (NS), received a rescue dose of levobupivacaine. Median VAS in Group A_0.125 was lower than in Group B_0.0625 on T_1h (8 ± 11 vs 16 ± 11; P < 0.05), and on T_4h (11 ± 8 vs 18 ± 1; P < 0.05). All patients remained hemodynamically stable. There were no significant differences between groups for postoperative joints mobility.

Conclusion:

Levobupivacaine at a dose of 1.25 mg/h administered by CSA provides good quality analgesia independent of concentration and solution volume in patients undergoing total knee and hip replacement.