TITLE: LOW INCIDENCE OF SIDE EFFECTS AFTER SPINAL ANESTHESIA WITH HEAVY LIGNOCAINE THROUGH A QUINCKE NEEDLE

AUTHORS: Mats G. Enlund, MD, PhD
AFFILIATION: Uppsala University, Uppsala, Sweden.

INTRODUCTION: The needle bevel has been pointed out as an important causal factor of post dural puncture headache (PDPH). The cutting Quincke needle has been regarded as unfavorable in this respect (1). Undiluted hyperbaric lignocaine 50mg/mL (UHL) has been considered as a major contributor to transient radicular irritation (TRI) (2). At our short-stay-surgical clinic, mainly day-cases, 27 G Quincke needle and UHL are the most commonly used tools for spinal anesthesia (SPA). In an ongoing quality assurance program all patients are interviewed by a nurse the first or second day post operatively by telephone (day-case, DC) or face to face (short-stay, SS).
METHODS: A structured interview for PDPH and TRI detec- tion was included in the program. 1. Have you had any problem after your spinal anesthetic? 2. If so, please describe the problem. 3. To what extent have your daily living been disturbed? Considerably/moderately/slightly/ not at all. 4. Would you like to have another spinal anesthetic in the future? 250 of the first 275 patient interviews were analyzed.
RESULTS: 25 of the DC patients were not reached by iterated attempts to contact by telephone. 225/275 SPA were performed as DC and 25 as SS. 223/225 and 0/25 of DC and SS patients, respectively, were anesthetized with UHL. One SS-patient was given plain bupivacaine 5mg/mL, the other 26 patients were given hyperbaric bupivacaine 5mg/mL. 25G Quincke needles were used for 5 patients, 27G Quincke needles were otherwise used. One patient reported symptoms of PDPH, lasting for 3-4 days. Another patient reported symptoms indicating meningitis, but she was lately found to have pyelonephritis. One patient, given UHL through a 27G needle in the sitting position, reported symptoms indicating TRI, slightly disturbing her daily living for a week. Two months later she chose to have a new SPA for a re- operation. This time the UHL was diluted with an equal amount of saline (not included in this report).
DISCUSSION: The low incidence of PDPH is remarkable. High age does not fully explain this (29% < 40 years of age). The low incidence of TRI is in obvious contrast with recent literature (2). Some of the 25 patients not contacted might, however, suffer from PDPH or TRI. Still, the figures must be considered as low. The quality program will continue without major alterations.
REFERENCES:

(1). Acta Anaesthesiol Scand 1999;43:488.

(2). Acta Anaesthesiol Scand 1999;43:359.