Post dural puncture headache after spinal anaesthesia for caesarean section: a comparison of 25 g Quincke, 27 g Quincke and 27 g Whitacre spinal needles.
OBJECTIVE
To compare the frequency and severity of post dural puncture headache in obstetric patients using 25G Quincke, 27G Quincke and 27G Whitacre spinal needles.


METHODS
Comparative, randomized, double-blind, interventional study.


METHODS
Liaquat University Hospital Hyderabad from October 2005 to December 2006.


METHODS
480 ASA I-II full term pregnant women, 18 to 45 years of age, scheduled for elective Caesarean section, under spinal anaesthesia, were randomized into three groups: Group I (25G Quincke spinal needle: n=168), Group II (27G Quincke spinal needle: n=160) and Group III (27G Whitacre spinal needle: n=152). Spinal anaesthesia was performed with 1.5-2.0 ml 0.75% hyperbaric bupivacaine using 25G Quincke spinal needle (Group I), 27G Quincke spinal needle (Group II) and 27G Whitacre spinal needle (Group III) at L3-4 inter-vertebral space. Each patient was assessed daily for four consecutive days following Caesarean section. Frequency and severity and of postdural puncture headache (PDPH) were recorded. Data were analyzed using SPSS-11.


RESULTS
Frequency of PDPH following the use of 25G Quincke (Group I), 27G Quincke (Group II) and 27G Whitacre (Group III) spinal needles was 8.3% (14/168), 3.8% (6/160) and 2.0% (3/152) respectively. In Group I, PDPH was mild in 5 patients, moderate in 7 patients and severe in 2 patients. In Group II, it was mild in 2, moderate in 3 and severe in 1 patient. In group III, it was mild in 2 and moderate in 1 patient. Severe PDPH did not occur in Group III. Most of the patients with PDPH developed it on 1st and 2nd postoperative day.


CONCLUSIONS
When using a 27G Whitacre spinal needle, the frequency and severity of PDPH was significantly lower than when a 25G Quincke or 27G Quincke needle was used.
Shaikh
Jan Muhammad
JM
Department of Anaesthesiology & Intensive Care, Liaquat University of Medical & Health Sciences, Jamshoro, Sindh, Pakistan. dr_janmohammad@hotmail.com
Memon
Amna
A
Memon
Muhammad Ali
MA
Khan
Majida
M
D000293:Adolescent; D000328:Adult; D000773:Anesthesia, Obstetrical / Q000295:instrumentation*; D000775:Anesthesia, Spinal / Q000295:instrumentation*; D002585:Cesarean Section; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008875:Middle Aged; D009339:Needles; D010154:Pakistan / Q000453:epidemiology; D051299:Post-Dural Puncture Headache / Q000453:epidemiology*; D011247:Pregnancy