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. 2017 Apr 7;2017(4):CD010807. doi: 10.1002/14651858.CD010807.pub2

Lynch 1992a.

Methods

  • Design: parallel‐group (2 arms)

  • Country: Germany

  • Multisite: no

  • International: no

  • Needle type design used: Quincke vs Whitacre

  • Needle diameter used: 25 vs 22

  • Procedure: anaesthesia

  • Number of attempts: unknown

  • Site of the puncture: L3‐4

  • Training level of those who administered the puncture: unknown

  • Median or paramedian technique: median approach

  • Type of anaesthesia: 0.5% hyperbaric bupivacaine

  • Patient position: lateral or sitting position
Participants 1. 300 patients (ASA I or II) aged 15 to 40 years (196 male, 104 female) undergoing elective orthopaedic procedures were enrolled
Exclusion criteria: migraine or chronic severe headache, infection, local anaesthetic allergy or a preference for general anaesthesia
Patients randomized to:

  • Quincke group: 150 patients (50%)

  • Whitacre group: 150 patients (50%)


2. No patients were excluded from analysis
3. Main characteristics of patients:

  • Age (mean, SD): Quincke group: 25, 1; Whitacre group: 27.8, 1

  • Men (number): Quincke group: 95; Whitacre group: 101

  • Weight (mean, SD): Quincke group: 73, 1; Whitacre group: 73.8, 1
Interventions

  • 29 G Quincke: Spinocan, Braun

  • 22 G Whitacre group: Becton Dickinson or Monoject


All punctures were done with a 20 G introducer (Braun, Germany)
Outcomes Outcomes were not classified as primary or secondary

  1. PDPH

  2. Severity of PDPH

  3. Backache
Notes

  1. Trial registration: not stated

  2. Funder: not stated

  3. Role of funder: not stated

  4. A priori sample size estimation: no

  5. Conducted: not stated

  6. Declared conflicts of interest: not stated
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Insufficient information to score this item as low or high risk of bias. Quote: "Patients were allocated randomly to have (…)" (page 58)
Allocation concealment (selection bias) Unclear risk Insufficient information to score this item as low or high risk of bias
Blinding of participants (performance bias) Unclear risk Insufficient information to score this item as low or high risk of bias
Blinding of outcome assessment (detection bias) 
 All outcomes Unclear risk Insufficient information to score this item as low or high risk of bias
Incomplete outcome data (attrition bias) 
 All outcomes Low risk No patients were lost to follow‐up
Selective reporting (reporting bias) High risk Adverse events, additional to PDPH, were not reported. Presence of associated symptoms is mentioned in methods, but not reported.
Other bias Low risk No other biases were identified