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OBSTETRIC ANESTHESIA

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

Magee-Womens Hospital, University of Pittsburgh School of Medicine, Department of Anesthesiology, Pittsburgh, Pennsylvania

Address correspondence and reprint requests to Manuel C. Vallejo, MD, Magee-Womens Hospital, Department of Anesthesiology, 300 Halket St., Pittsburgh, PA 15213. Address e-mail to vallejomc{at}anes.upmc.edu

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, 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.

Implications: We compared the rates of postdural puncture headache and epidural blood patch (EBP) with five different spinal needles in obstetric patients undergoing cesarean delivery. The least expensive Quincke needle had the highest postdural puncture headache and EBP rates. Patient discomfort as well as the cost of an EBP must be considered when choosing a spinal needle. Our results support using pencil-point spinal needles in obstetric patients.

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