Effect of Needle Bevel Direction on the Postspinal Headache in Young Males of the Third Age Decade

Son, Ju Tae

Abstract

The incidence of postspinal headache is one of the well known complications of spinal anesthesia. The development of postspinal headache is related to age and sex of patients, needle size, needle configuration, pregnancy, direction of needle bevel, number of dural puncture. This study was done to see the effect of various gauge Quincke needles(22, 23, 24, 25, 26gauge) and needle bevel direction on the incidence, severity, onset and location of postspinal headache in the 200 male patients of the third age decade undergoing spinal anesthesia. There were one group consisting of 100 patients who underwent parallel insertion to longitudinal dural fibers and the other group consisting of 100 patients who underwent vertical. Each group consisting of 100 patients had five subgroups with 20 patients in related to each needle gauge. A system of criteria for registering postspinal headache and its severity is proposed. The following results were observed: 1) The incidence of postspinal headache was 10% in one group who underwent parallel insertion to longitudinal dural fibers but 27% in the other group who underwent vertical. 2) The severity of headache was mild level in all the 10 cases with postspinal headache of parallel insertion group but above moderate level in 14 cases of all the 27 cases with postspinal headache of vertical insertion group. 3) The small size of needle had a trend with lower incidence of postspinal headache than the large size . 4) The onset of postspinal headache was within 3 day after spinal anesthesia in the almost patients(92.5%) with postspinal headache. 6) The sites of postspinal headache were 59.5% in frontal, 18.9% in occipital, 16.2% in generalized, 5.4% in parietal region. In conclusion, the method of insertion parallel to longitudinal dural fibers is significantly lower incidence of postspinal headache than that of insertion vertical to longitudinal dural fibers in young males of the third age decade.