Spinal Anaesthesia for Caesarean Section: Comparison of 22-Gauge and 25-Gauge Whitacre Needles With 26-Gauge Quincke Needles

Abstract

We have studied 150 women undergoing elective Caesarean section under spinal anaesthesia. They were allocated randomly to have a 22-gauge Whitacre, a 25-gauge Whitacre or a 26-gauge Quincke needle inserted into the lumbar subarachnoid space. The groups were compared for ease of insertion, number of attempted needle insertions before identification of cerebrospinal fluid, quality of subsequent analgesia and incidence of postoperative complications. There were differences between groups, but they did not reach statistical significance. Postdural puncture headache (PDPH) was experienced by one mother in the 22-gauge Whitacre group, none in the 25-gauge Whitacre group and five in the 26-gauge Quincke group. Five of the six PDPH occurred after a single successful needle insertion. Seven of the 15 mothers in whom more than two needle insertions were made experienced backache, compared with 12 of the 129 receiving two or less (P < 0.001). We conclude that the use of 22- and 25-gauge Whitacre needles in elective Caesarean section patients is associated with a low incidence of PDPH and that postoperative backache is more likely when more than two attempts are made to insert a spinal needle.

Incidence of Postdural Puncture Headache after Caesarean Section Comparison Between 25G and 27G Quincke Variety of Spinal Needle

“…The overall incidence of postdural puncture headache ranges from 0% to 37% as reported by various authors 25 30 , which closely resembles our study, demonstrated PDPH incidence of 20%, and 12.5% patients with 25G Quincke, and 27G Quincke needles respectively. Although frequency of PDPH was relatively higher in all the three groups in that study, it was again clearly observed that 27G Whitacre needle reduced the frequency of PDPH in patients undergoing Caesarean section.…”

Does Atraucan cause more postdural puncture backache?

“…However, some studies have shown no difference in PDPB related to the needle size and shape (7,11). The second hypothesis is that repeated spinal puncture attempts cause PDPB (16). However, some studies revealed this to be untrue.…”

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.…”