title: Postdural puncture headache: comparison of 25-gauge Whitacre and Quincke needles.
abstract: OBJECTIVE
  To evaluate the influence of the shape of the needle tip on postdural puncture headache (PDPH) independent of the needle diameter, a 25-gauge Whitacre and a 25-gauge Quincke needle were compared.
  
  
  METHODS
  In a prospective, randomized, double-blind fashion, the study was carried out on 400 patients who received spinal anesthesia for operations of the lower extremities. The 25-gauge Whitacre needle (group 1) and the 25-gauge Quincke needle (group 2) were randomly assigned to the patients, 200 in each group. Patients were interviewed postoperatively on days 1, 3, 5, and 7 using a standardized questionnaire. Only postural headache was defined as PDPH. The intensity of both postural and nonpostural headache were quantified using a 4-point rating scale and a visual analog pain scale (VAS). Statistical analysis was performed with parametric and nonparametric tests when appropriate, p < or = 0.05 was considered as significant.
  
  
  RESULTS
  There were no differences in age and sex distribution between the two groups. Significantly more patients in group 2 (8.5%) complained of PDPH than in group 1 (3%, p < or = 0.02). Duration of PDPH ranged from 1-3 days (median: 1) in group 1, and from 1-9 days (median: 3) in group 2. This difference closely approached significance (p = 0.058). The mean maximal intensity of PDPH was comparable in both groups. Severe PDPH occurred only in two patients of group 2. One of them required a blood patch. With respect to the nonpostural headache, no significant differences were seen.
  
  
  CONCLUSIONS
  The use of a conical tipped Whitacre needle results in significantly less PDPH compared to a standard Quincke spinal needle of the same size.
authors.affiliation: Department of Anesthesiology and Intensive Care, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Buettner
authors.forename: K P
authors.initials: KP
authors.lastname: Wresch
authors.forename: R
authors.initials: R
authors.lastname: Klose
mesh_terms: D000328:Adult; D000775:Anesthesia, Spinal; D004311:Double-Blind Method; D005260:Female; D006261:Headache / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009339:Needles; D011446:Prospective Studies; D013129:Spinal Puncture / Q000009:adverse effects*; D013997:Time Factors