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PubMed1980

Lumbar puncture.

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Deamino Arginine Vasopressin↗
PubMed1990

[Inner ear hearing loss following cerebrospinal fluid puncture: a too little appreciated complication?].

Lumbar puncture for myelography, spinal anaesthesia and aspiration of cerebrospinal fluid is a very common procedure. Although it has been known for a long time that hearing impairment may be a late complication, only a few case reports have been published, and not all have included audiograms. We present nine cases of hearing loss following myelography, lumbar puncture and spinal anaesthesia. It appears likely that this rare complication arises only in subjects with a wholly or partially patent cochlear aqueduct, allowing loss of perilymphatic fluid into the cerebrospinal space. Hearing loss was seen in eight of nine patients in the lower frequencies and in six of nine patients on both sides. Hearing recovered in six of nine patients. Transient hearing loss may occur more often than is generally assumed, and the symptom can remain unnoticed. Since not all of these hearing losses proved to be fully reversible, we suggest to inform patients about this complication for medico-legal reasons.

Adult↗
PubMed2000

Postdural puncture headache: a randomized comparison of five spinal needles in obstetric patients.

This prospective, blinded, randomized study compares the incidence of postdural puncture headache (PDPH) and the epidural blood patch (EBP) rate for five spinal needles when used in obstetric patients. One thousand two women undergoing elective cesarean delivery under spinal anesthesia were recruited. We used two cutting needles: 26-gauge Atraucan and 25-gauge Quincke, and three pencil-point needles: 24-gauge Gertie Marx (GM), 24-gauge Sprotte, and 25-gauge Whitacre. The needle for each weekday was chosen randomly. Cutting needles were inserted parallel to the dural fibers. The incidences of PDPH were, respectively, 5%, 8.7%, 4%, 2.8%, and 3.1% for Atraucan, Quincke, GM, Sprotte, and Whitacre needles (P = 0.04, chi(2) analysis), and the corresponding EBP rates in those with PDPH were 55%, 66%, 12.5%, 0%, and 0% (P = 0.000). The Quincke needle had a more frequent PDPH rate than the Sprotte or the Whitacre needle (P = 0.02) and a more frequent EBP rate than the GM, Sprotte, or the Whitacre needle (P = 0.01). The Atraucan needle had a more frequent EBP rate than the Sprotte or Whitacre needle (P = 0.05). Neither the PDPH rate nor the EBP rates differed among the pencil-point needles. The cost of EBP must be taken into consideration when choosing a spinal needle. We conclude that pencil-point spinal needles should be used for subarachnoid anesthesia in obstetric patients.

Adult↗
PubMed2006

Postdural puncture headache: a cross-sectional study of incidence and severity in a new obstetric anaesthesia unit.

Postdural puncture headache remains a major complication of subarachnoid anaesthesia that bothers the anaesthetist and the young mother. Identification of factors that may affect PDPH after caesarean section under subarachnoid anaesthesia could be critical to policy formulation in an emerging obstetric anaesthesia unit. All patients who had caesarean section under subarachnoid anaesthesia were evaluated in a cross-sectional manner. Only patients in whom 25G Quincke needles were employed for lumbar puncture were recruited for analysis. Patients who met criteria for postdural puncture headache were interviewed on postoperative day 3. The PDPH was further characterized to establish the time of onset, location of headache, limitation of activity of daily living, and methods of management. A total of 119 patients had lumbar puncture for spinal anaesthesia. Spinal anaesthesia was successful in 112 patients, inadequate in 6 patients and failed in one. Twenty-seven patients (22.7%) developed PDPH. There was no difference in the demographic features in the patients who developed PDPH and those without headache. Clinical variables like site and number of attempts at dural puncture (p = 0.82. Chi-square test), traumatic attempts. parasthesia and volume of bupivacaine were not found to be determinants of PDPH. Successful dural puncture was achieved on first attempt in 42.0% (n = 47) of the patients. The PDPH was mainly occipital for most of the women, starting on postoperative day 2 and relieved with liberal fluids and paracetamol. Maternal experience of their caesarean section with spinal anaesthesia was satisfactory in 77.8% (n = 21) of patients and 63% (n = 17) would recommend the technique to other women.

Adult↗
PubMedDate not supplied

Post-lumbar puncture headache as a complication of spinal anesthesia.

Spinal anesthesia is a frequently used technique for surgery of the lower extremities. A complication of this form of regional anesthesia is post-lumbar puncture headache. Rapid diagnosis and treatment are essential in preventing prolonged disability and neurologic sequelae. Two case reports are presented, followed by a review of the literature concerning etiology, diagnosis, and treatment of post-lumbar puncture headache.

Anesthesia, Spinal↗
PubMed1989

[A space-occupying hemorrhage following spinal anesthesia in the presence of an undiagnosed small spinal tumor (ependymoma)].

Space-occupying subarachnoid bleeding after atraumatic puncture of the spinal canal for spinal anesthesia in a patient with no coagulation disorders or anticoagulant therapy is described. The hematoma was caused by puncturing a previously undiagnosed small spinal ependymoma. A thorough and specific preoperative evaluation is of importance to minimize the risks associated with spinal anesthesia.

Anesthesia, Spinal↗
PubMedDate not supplied

Role of needle gauge and tip configuration in the production of lumbar puncture headache.

BACKGROUND AND OBJECTIVES: Postdural puncture headache (PDPH) is a morbidity that occurs frequently after lumbar puncture. The purpose of this study was to evaluate the role of needle diameter and tip configuration in causing PDPH. The incidence of PDPH was evaluated in parturients because this group of patients is at high risk for developing PDPH and because they often undergo lumbar puncture for spinal anesthesia. METHODS: The incidence of PDPH after spinal anesthesia with 26- and 27-gauge Quincke and 25-gauge Whitacre needles was studied in a series of 4,125 parturients undergoing spinal anesthesia over a 4-year period. Data were also collected on the incidence of PDPH with 17-gauge Huber-tipped Weiss needles in 21,578 parturients receiving lumbar epidural analgesia and/or anesthesia over the same interval. Additionally, the need to treat PDPH with epidural blood patch in all of these patients was studied. RESULTS: The incidence of PDPH was 5.2% with 26-gauge Quincke needles (1987-1989), 2.7% with 27-gauge Quincke needles (1989-1990), and 1.2% with 25-gauge Whitacre needles (1990-1991). During the same periods, the incidence of PDPH with 17-gauge Weiss needles averaged 1.1%, 1.7% and 1.2%, respectively. As compared with the 26-gauge Quincke needle, there was a lower incidence of PDPH with the 27-gauge Quincke (P < .006) and 25-gauge Whitacre spinal needles (P < .001). The incidence of PDPH with the 25-gauge Whitacre needle was less than that with the 27-gauge Quincke needle (P < .05), and it was similar to the overall rate of headache, which occurs occasionally from accidental dural puncture during the performance of lumbar epidural analgesia/anesthesia for labor and cesarean delivery (P = .974). The need for treating PDPH with epidural blood patching was greatest with the 17-gauge Weiss epidural needle (75.3% of cases), but was similar with the various spinal needles (13-39%). However, because the Whitacre needle produced the fewest PDPHs, it was associated with the lowest absolute requirement for epidural blood patching. CONCLUSIONS: The morbidity associated with lumbar puncture can be decreased by selecting the proper needle gauge and tip configuration. Use of the smallest gauge needle and one that has a noncutting Whitacre tip produces the lowest incidence of PDPH in parturients, a group of patients at increased risk for developing PDPH.

Anesthesia, Obstetrical↗