title: Lower incidence of postdural puncture headache using whitacre spinal needles after spinal anesthesia: A meta-analysis.
abstract: OBJECTIVE
  The aim of this meta-analysis was to evaluate the postdural puncture headache after spinal anesthesia with Whitacre spinal needles compared with Quincke spine needles.
  
  
  METHODS
  We searched several databases, including PubMed, Embase, ISI Web of Knowledge, and Cochrane Central Register of Controlled Trials until October 10th, 2014, for randomized controlled trials that compared spinal anesthesia with Whitacre spinal needles or Quincke spine needles for postdural puncture headache. Two reviewers independently screened the literature, assessed the risk for bias and extracted data. We used RevMan 5.3 software to perform the meta-analysis. Studies were included for the main end points if they addressed the following: frequency of postdural puncture headache, severity of postdural puncture headache as assessed by limitation of activities, and frequency of epidural blood patch.
  
  
  RESULTS
  Nine randomized controlled trials were included for meta-analysis. The meta-analysis showed that spinal anesthesia with Whitacre spinal needles achieved lower incidence of postdural puncture headache(RR 0.34; 95% CI [0.22, 0.52]; P < .00001); in addition, the severity of postdural puncture headache was lower in the Whitacre spinal needle group (RR 0.32; 95% CI [0.16, 0.66]; P = .002). Furthermore, the frequency of an epidural blood patch in the Whitacre spinal needle group was lower compared with that in the Quincke spine needle group (RR 0.15; 95% CI [0.04, 0.51]; P = .002).
  
  
  CONCLUSIONS
  We suggest the Whitacre spinal needles as a superior choice for spinal anesthesia compared with Quincke spine needles.
authors.affiliation: Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China.
authors.forename: Di
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China.
authors.forename: LingXiao
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China.
authors.forename: XingYu
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China.
authors.forename: XiaoBo
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China.
authors.forename: YuLin
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China.
authors.forename: GuangZhi
authors.initials: G
authors.lastname: Ning
authors.affiliation: Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China.
authors.forename: ShiQing
authors.initials: S
authors.lastname: Feng
mesh_terms: D000775:Anesthesia, Spinal / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D015994:Incidence; D009339:Needles; D051299:Post-Dural Puncture Headache / Q000453:epidemiology* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D013129:Spinal Puncture / Q000009:adverse effects / Q000295:instrumentation
keywords: Quincke spine needles; Whitacre spinal needles; meta-analysis; postdural puncture headache; spinal anesthesia