Postdural Puncture Headache: A Randomized Comparison of Five Spinal Needles in Obstetric Patients

Abstract

This prospective, blinded, randomized study compares the incidence of postdural puncture headache (PDPH) and the epidural blood patch (EBP) rate for five spinal needles when used in obstetric patients. One thousand two women undergoing elective cesarean delivery under spinal anesthesia were recruited. We used two cutting needles: 26-gauge Atraucan and 25-gauge Quincke, and three pencil-point needles: 24-gauge Gertie Marx (GM), 24-gauge Sprotte, and 25-gauge Whitacre. The needle for each weekday was chosen randomly. Cutting needles were inserted parallel to the dural fibers. The incidences of PDPH were, respectively, 5%, 8.7%, 4%, 2.8%, and 3.1% for Atraucan, Quincke, GM, Sprotte, and Whitacre needles (P = 0.04, chi(2) analysis), and the corresponding EBP rates in those with PDPH were 55%, 66%, 12.5%, 0%, and 0% (P = 0.000). The Quincke needle had a more frequent PDPH rate than the Sprotte or the Whitacre needle (P = 0.02) and a more frequent EBP rate than the GM, Sprotte, or the Whitacre needle (P = 0.01). The Atraucan needle had a more frequent EBP rate than the Sprotte or Whitacre needle (P = 0.05). Neither the PDPH rate nor the EBP rates differed among the pencil-point needles. The cost of EBP must be taken into consideration when choosing a spinal needle. We conclude that pencil-point spinal needles should be used for subarachnoid anesthesia in obstetric patients.

PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies

“…Thirty-nine studies (16 RCT, [10][11][12]14,[16][17][18][19][20][21]23,24,26,[28][29][30] ten cohort studies, [33][34][35][36][38][39][40][41][42][43] and 13 case series 45,[47][48][49][50][51][53][54][55][56][57][58][59][60] ) contained data on frequency of ADP or PDPH (Table I). Figures 1 to 3 summarize the meta-analyses of ADP and PDPH risks for different epidural and spinal needles.…”

Comparison Of Blunt And Sharp Needles For Transforaminal Epidural Steroid Injections

“…[11] There are many studies proving that blunt-tipped needles reduce the incidence of headache. [12][13][14][15] Westbrook et al [15] and Ready et al, [13] in their distinct studies with blunt-and sharp needles having the same outer diameter, found that CSF loss was less with blunt needles. Katı et al, [16,17] in a study with 60 patients, did not find any statistically significant difference between blunt and sharp needles with regard to headache.…”

“…In the studies with spinal anesthesia practices comparing the blunt needles and sharp needles with smaller diameter, it was reported that blunt needles were less likely to cause to headache. [13][14][15] Vascular penetration during invasive processes is a risk factor that may happen in all injection procedures. Potential complications of this situation are bleeding, hematoma formation, and intravascular drug injection.…”

The effect of epidural needle type on postdural puncture headache: a randomized trial

“…6 The Sprotte spinal needle (Pajunk GMBH, Geisingen, Germany) has been associated with a low incidence of PDPH in parturients. [7][8][9][10][11] The Special Sprotte™ epidural needle is a modification of the non-cutting Sprotte spinal needle. It has a solid bullet-shaped tip with a lateral opening for passage of an epidural catheter.…”