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BJA Advance Access published online on February 18, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei100
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org
Accepted December 17, 2004

Clinical Investigation

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

U. W. Gosch 1*, M. Hueppe 1, M. Hallschmid 2, J. Born 2, P. Schmucker 1, and T. Meier 1

1 Department of Anaesthesiology, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
2 Department of Neuroendocrinology, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany

* To whom correspondence should be addressed.
U. W. Gosch, E-mail: u-gosch{at}foni.net


  Abstract

Background. To reduce the risk of post-dural puncture headache (PDPH) in continuous spinal anaesthesia, small-gauge spinal catheter systems with different techniques of dural perforation have 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 young healthy volunteers (age 18-30 yr), who were enrolled in a neuroendocrinological investigation for analysis of neuropeptides in cerebrospinal fluid (CSF). After intermittent sampling of CSF (17x0.5 ml over 4 h), the catheter was removed and the development of PDPH and pain intensity were documented prospectively by the subjects in a standardized headache assessment (11-point numerical 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 shorter duration of PDPH (2.4 [SD 2.3] vs 5.1 [3.1] days, P=0.050) and lower 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 of the catheter over-needle technique for the reduction of the duration and intensity of PDPH.

Keywords: anaesthetic techniques, over-needle technique; complications, post-dural puncture headache; equipment, catheters, spinal.
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