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LETTERS TO THE EDITOR

Does Intrathecal Mepivacaine Cause Post Lumbar Puncture Headache?

Women’s and Children’s Hospital, USC Medical Center, Los Angeles, CA

To the Editor:

In the article by Meininger, et al. (1), the authors report an incidence of post lumbar puncture headache of nearly 10% (9/100) using a 25-gauge pencil-point needle. This is a more frequent incidence than is usually found with this type of needle and is of the same order of magnitude as used to occur using 25-gauge Quincke needles. The authors do not comment on this nor do they mention how many patients required epidural blood patch for treatment.

I wonder if mepivacaine could be the reason for this phenomenon.

Reference

1. Meininger D, Byhahn C, Kessler P, et al. Intrathecal fentanyl, sufentanil, or placebo combined with hyperbaric mepivacaine 2% for parturients undergoing elective cesarean delivery. Anesth Analg 2003; 96: 852–8.[Abstract/Free Full Text]

Response

Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum der Johann Wolfgang Goethe Universität Frankfurt, Frankfurt, Germany

In Response:

We thank Dr. Lee for his interest in our article. We agree with Dr. Lee that an incidence of postdural puncture headache (PDPH) of 9% using a 25-gauge pencil-point needle has been higher than the incidence reported by Vallejo et al. using this type of needle (1). In our study, all parturients were seen postoperatively every 24 h for the first 72 h after spinal anesthesia by a resident or staff physician. Parturients were asked for the presence or absence of headache and any accompanying symptoms. PDPH as well as any kind of postpartal headache were recorded and all patients have been treated like patients with PDPH leading to an overall incidence of headache of 9%. Severe postdural puncture headache requiring an epidural blood patch has not been recorded in our study group, headache has always been described as mild and resolved spontaneously (2).

References

1. Vallejo MC, Mandell GL, Sabo DP, Ramanathan S. Postdural puncture headache: a randomized comparison of five spinal needles in obstetric patients. Anesth Analg 2000; 91: 916–20.[Abstract/Free Full Text]
2. Meininger D, Byhahn C, Kessler P, et al. Intrathecal fentanyl, sufentanil, or placebo combined with hyperbaric mepivacaine 2% for parturients undergoing elective cesarean delivery. Anesth Analg 2003; 96: 852–8.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Lee, J. S. Articles by Meininger, D. Search for Related Content PubMed PubMed Citation Articles by Lee, J. S. Articles by Meininger, D.