Quincke) in spinal anesthesia on the incidence of transient neurologic syndrome: A randomized clinical trial

Background and Aims

Transient neurologic syndrome (TNS) is a postoperative pain in the back and buttock that can occur after spinal anesthesia. The spinal needle design may have an impact on the occurrence of TNS. We decided to compare the incidence of TNS and related factors between two spinal needle types.

Methods

In this randomized clinical trial, 150 patients aged 18-60 years and American Society of Anesthesiologists (ASA) physical status I who underwent lower abdomen or lower extremity surgeries with spinal anesthesia and supine position were enrolled. They were randomly divided into two groups (25 G Quincke or Sprotte needle) with 0.5% bupivacaine (12.5 mg). After the operation, the patients were asked to report any pain in the lower back, buttock, and thigh areas. A Visual Analog Scale (VAS) was also used to record the severity of the pain.

Results

Overall, 45 patients developed TNS. Twenty-nine patients in the Sprotte group (38.7%) and 16 patients in the Quincke group (21.3%) developed TNS (p = 0.75). More patients in the Sprotte group (25.3%) had severe pain (VAS score of 8-10) when compared with the Quincke group (6.7%). There was no significant difference in TNS symptoms duration between the two groups. In about half of patients (51.9%) in the Sprotte group and 57.3% of patients in the Quincke group, the symptoms resolved after 2-3 h.

Conclusion

Although the incidence of TNS did not differ significantly, patients for whom a Sprotte spinal needle had been used had more severe pain. This suggests that the Quincke needle caused less severe pain.

Effects of different anesthesia methods on postoperative transient neurological syndrome in patients with lumbar disc herniation

The objective of the present study was to investigate the effects of different anesthesia methods on postoperative transient neurologic syndrome (TNS) in patients with lumbar disc herniation (LDH). Ninety-six patients with LDH were selected from November 2015 to October 2016 in Cangzhou Central hospital. All patients were treated with percutaneous transforaminal endoscopic discectomy. The patients were randomly divided into the control group and observation group, with 48 patients each. Combined spinal-epidural anesthesia was performed for patients in the control group, while epidural anesthesia was applied in the observation group. The levels of T lymphocyte subsets (CD4⁺ and CD8⁺) and inflammatory factors (IL-2 and TNF-α) were measured and compared before and 1 week after surgery. The incidence rate of TNS within 1 week after surgery was compared between the two groups. Fugl-Meyer Assessment was used to evaluate lower limb motor function and sensory disturbances at 1, 3 and 5 days after treatment. One week after treatment, the serum levels of CD4⁺ and CD8⁺ in the two groups were significantly lower than those before surgery (p<0.05), but no significant differences were found between the groups (p>0.05). The incidence rate of TNS within 1 week after surgery was significantly lower in the observation group than in the control group (p<0.05). The scores of lower limb motor function and sensory disturbances in the observation group evaluated at 1, 3 and 5 days after treatment were significantly higher than those in the control group (p<0.05). In conclusion, combined spinal-epidural anesthesia and epidural anesthesia caused no significant differences in immune function or inflammatory indexes in patients with LDH. However, the application of epidural anesthesia significantly reduced the incidence rate of postoperative TNS, which in turn reduced nerve damage.