Comparison of two spinal needle types to achieve a unilateral spinal block

• Published in: Journal of anesthesia 2013-04, Vol.27 (2), p.224-230
• Main Authors: Kuusniemi, Kristiina, Leino, Kari, Lertola, Kaarlo, Pihlajamäki, Kalevi, Pitkänen, Mikko
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anesthesia; Anesthesia, Spinal - adverse effects; Anesthesia, Spinal - instrumentation; Anesthesia, Spinal - methods; Anesthesiology; Anesthetics, Local - administration & dosage; Bupivacaine; Bupivacaine - administration & dosage; Comparative analysis; Complications and side effects; Critical Care Medicine; Dosage and administration; Double-Blind Method; Drug therapy; Emergency Medicine; Endpoint Determination; Female; Health aspects; Humans; Intensive; Intraoperative Complications - epidemiology; Lower Extremity - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Needles - adverse effects; Needlework; Nerve Block - instrumentation; Nerve Block - methods; Original Article; Pain - epidemiology; Pain - etiology; Pain Medicine; Pain, Postoperative - epidemiology; Patient Positioning; Patient Satisfaction; Postoperative Complications - epidemiology; Prospective Studies; Spinal diseases; Young Adult
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-012-1496-1

Purpose Unilateral spinal anesthesia is beneficial in patients undergoing unilateral leg surgery. The direction and the shape of the spinal needle are thought to influence the unilateral distribution of the local anesthetic in the intrathecal space. Therefore, to study the effects of different spinal needles we compared the effects of the Whitacre and Quincke spinal needles. Methods This was a prospective, randomized, double-blind study of 60 consecutive outpatients scheduled for unilateral lower-limb surgery. The patients were randomized to receive spinal anesthesia with 1.2 ml of 0.5 % plain bupivacaine using either a 27-G Whitacre or a Quincke needle. One half of the local anesthetic was injected towards the nondependent side and the other half was directed cranially. The spread of spinal anesthesia, both sensory and motor blocks, was defined as the primary endpoint and was recorded at 10, 20, and 30 min after the spinal injection, at the end of the operation, 2 h after the spinal injection, and every 30 min thereafter until there was no motor block. Secondary endpoints included patient satisfaction and adverse effects. Results There was no difference in the spread of sensory or motor blocks between the Whitacre and the Quincke groups. However, the sensory and motor blocks on the operated and the nonoperated sides were significantly different at all testing times, as expected. There was no difference in the incidence of adverse effects or patient satisfaction scores between the Whitacre and the Quincke groups. Conclusion Unilateral spinal block for outpatient surgery can be achieved with both pencil-point (Whitacre) and Quincke needles using 6.0 mg of plain bupivacaine. Neither the spread of sensory and motor blocks nor the corresponding recovery times appeared to be different between the groups. Nor was there any difference in patient satisfaction.