Needle design does not affect the success rate of spinal anaesthesia or the incidence of postpuncture complications in children

Background: In adults, pencil-point spinal needles are believed to be less traumatic and therefore to be superior compared to cutting-point needles wi th respect to success rate and postpuncture complications. The aim of this randomised, parallel groups and prospective study was to record the success rate and to evaluate the incidence of complications following spinal anaes thesia with the two types of needles in children. Methods: We studied 215 children aged 1 to 18 years. A 25-gauge needle was used in children up to 7 years (n=96) and a 27-gauge needle in older childr en (n=119). During lumbar puncture with either a cutting-point (n=109) or a pencil-point (n=106) spinal needle, we recorded puncture characteristics a nd the success of cerebrospinal fluid (CSF) aspiration. Hyperbaric bupivaca ine 5 mg ml(-1) at a dose of 0.3-0.4 mg kg(-1) was used for the spinal anae sthesia. The incidence of postdural puncture complications was recorded fro m diaries completed by the children and parents one week after the lumbar p uncture. Results: The success rate of the spinal anaesthesia was 97% without differe nce between the needles. The success rate was higher when the aspiration of CSF was easy compared to if it was difficult (98% vs. 88% P=0.02). Two hun dred and seven diaries were returned (97%). Twenty-four children developed a headache, 8 of which were classified as a postdural puncture headache (PD PH), 6 with the cutting-point needle and 2 with the pencil-point needle (n. s.). Nine children developed signs of transient radicular irritation with n o difference between the needles. Conclusion: Both types of spinal needles can be used in children, and a fre e aspiration of CSF results in a high success rate of the spinal block. Pos tpuncture complications are as common in children as in adults.