Abstract
Background: Performing spinal anesthesia with a thin gauge needle is technically difficult due to the flexibility of the needle and minimal pop sensation. In this study, we implemented a newly introduced technique of spinal anesthesia, that is the cerebrospinal fluid aspiration method, and compared it with the conventional popping method while using a 25-gauge Quincke type spinal needle.
Objective: The study compared the total procedural time, success rate of the first attempt to perform dura puncture, number of attempts, and incidence of post-Dural puncture headache using either CSF aspiration method or the conventional popping method in patients undergoing spinal anesthesia.
Design:Prospective, randomized, single-blinded controlled trial.
Participants:60 patients between 19 to 65 years of age, with American Society of Anesthesiologists physical status 1 or 2, undergoing surgeries below umbilical region under spinal anesthesia were enrolled in this study.
Method:The patients were randomly assigned to one of the two groups: 1) Patients receiving spinal anesthesia using the CSF aspiration method, in which the spinal needle is advanced with continuous aspiration. 2) The conventional popping method, in which a Dural pop or click is sensed by the anesthesiologist. The primary outcome measure was the total procedural time and success rate of the first attempt to perform Dural puncture. Number of attempts, time to complete motor block, withdrawal cases, and post-Dural puncture headache were also recorded.
Result:60 patients were included in this study. In the aspiration group, the total procedure time was significantly shorter than in popping group [P=0.039]. Moreover, In the popping group, the number of attempts was significantly higher than in the aspiration group [P = 0.018], whereas the success rate of the first attempt for Dural puncture was 93.3% compared to 70% in the popping group [P=0.020]. In the popping group, 4 withdrawal cases were reported, compared to aspiration group which had only one withdrawal case. There was no significant difference
between the number of passages and PDPH incidence between the two groups. However, 2 out of 60 cases of PDPH were reported, both belonging to the popping group.
Conclusion:The CSF aspiration method has several clinical benefits over conventional popping method for spinal anesthesia using 25-gauge Quincke-type spinal needle.