title: Comparison of post-dural puncture headache and low back pain between 23 and 25 gauge Quincke spinal needles in patients over 60 years: randomized, double-blind controlled trial.
abstract: BACKGROUND
  Even though the use of a 25 gauge or smaller Quincke needle is recommended for spinal anesthesia to reduce post-dural puncture headache in Korea, lumbar puncture in older patients using a 25 gauge or smaller Quincke needle can be difficult. However, most previous studies concerning post-dural puncture headache have chosen children, parturients, and young adults as study participants.
  
  
  OBJECTIVE
  The study compared post-dural puncture headache, post-operative back pain, and the number of lumbar puncture attempts using a 23 or 25 gauge Quincke needle for spinal anesthesia of Korean patients >60-years-of-age.
  
  
  METHODS
  Randomized, double-blinded controlled trial.
  
  
  METHODS
  The 53 participants who underwent orthopedic surgery under spinal anesthesia were recruited by informed notices from December 2006 through August 2007 at a 200-bed general hospital located in Kyunggido. Inclusion criteria were an age >60 years, ASA I-II, and administration of patient controlled analgesia for the first 48 h post-operatively.
  
  
  METHODS
  The 53 patients were randomly allocated to either the experimental (23 gauge Quincke needle) or control group (25 gauge Quincke needle). All patients had 24 h bed rest post-operatively. Post-dural puncture headache was assessed by the Dittmann Scale and post-operative back pain was assessed by a visual analogue scale at 24, 48, and 72 h post-operatively. The statistical methods included the Mann-Whitney U-test and Spearman correlation.
  
  
  RESULTS
  There were no differences in post-dural puncture headache, and post-operative back pain at 24, 48, and 72 h post-operatively, and no differences in the number of lumbar punctures, with the 23 and 25 gauge Quincke needle. Forty-eight hour post-operative back pain was positively associated with the number of lumbar punctures (p=.036) and age (p=.040). There were no statistically significant associations among post-dural puncture headache, the number of lumbar punctures, and 48 h post-operative back pain. Pre-operative back pain was positively associated with 48 h post-operative back pain (p<.001).
  
  
  CONCLUSIONS
  The choice of a 23 or 25 gauge Quincke needle for spinal anesthesia has no significant influence on post-dural puncture headache and post-operative back pain for Korean patients greater than 60-years-of-age. The 23 gauge Quincke needle is an option for lumbar punctures in this patient population.
authors.affiliation: Central Hospital, Kyunggido, Republic of Korea.
authors.forename: Meehyoung
authors.initials: M
authors.lastname: Kim
authors.forename: Haesang
authors.initials: H
authors.lastname: Yoon
mesh_terms: D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000295:instrumentation*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009339:Needles; D051299:Post-Dural Puncture Headache; D011446:Prospective Studies; D056910:Republic of Korea