title: Comparison of the 25-gauge Whitacre with the 24-gauge Sprotte spinal needle for elective caesarean section: cost implications.
abstract: Spinal anaesthesia provides rapid, safe anaesthesia for Caesarean section. The pencil-point spinal needles (Sprotte and Whitacre) are reported to have a low incidence of post-dural puncture headache (PDPH). As the 25G Whitacre is less expensive than the 24G Sprotte needle, this prospective, randomized, double-blind study was designed to compare the incidence of PDPH and ease of insertion of these needles in 304 ASA 1 and 2 women having elective Caesarean section under spinal anaesthesia. Each patient was assessed daily for five consecutive days following Caesarean section by an investigator blinded to the needle used. The results indicate that the two needles have a similar ease of insertion, number of failed insertions, and failed subarachnoid blockade. An inability to insert the spinal needles occurred in two patients in each group. Therefore, 150 patients in each group completed the study. The incidence of PDPH with the 24G Sprotte needle was 4.0% (6/150) compared with 0.66% (1/150) with the 25G Whitacre (NS). There was no correlation between the occurrence of PDPH and the difficulty of needle insertion, presence of transient hypotension or the effectiveness of anaesthesia delivered. This study indicates that both needles are comparable with respect to ease of insertion and incidence of PDPH. As the Whitacre needle is less expensive it is a reasonable alternative to the more expensive Sprotte needle.
authors.affiliation: Department of Anaesthesia, Faculty of Medicine, University of British Columbia, Grace Hospital, Vancouver, Canada.
authors.forename: D C
authors.initials: DC
authors.lastname: Campbell
authors.forename: M J
authors.initials: MJ
authors.lastname: Douglas
authors.forename: T J
authors.initials: TJ
authors.lastname: Pavy
authors.forename: P
authors.initials: P
authors.lastname: Merrick
authors.forename: M L
authors.initials: ML
authors.lastname: Flanagan
authors.forename: G H
authors.initials: GH
authors.lastname: McMorland
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D002045:Bupivacaine / Q000008:administration & dosage; D002585:Cesarean Section; D003365:Costs and Cost Analysis; D004311:Double-Blind Method; D004388:Dura Mater; D017558:Elective Surgical Procedures; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology; D006801:Humans; D007022:Hypotension / Q000209:etiology; D015994:Incidence; D009339:Needles / Q000191:economics; D009407:Nerve Block; D011247:Pregnancy; D011446:Prospective Studies; D013129:Spinal Puncture / Q000009:adverse effects / Q000295:instrumentation
chemical_list: D002045:Bupivacaine