JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (26) Citing Articles via Google Scholar Google Scholar Articles by Vallejo, M. C. Articles by Ramanathan, S. Search for Related Content PubMed PubMed Citation Articles by Vallejo, M. C. Articles by Ramanathan, S.

---

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.

This article has been cited by other articles:

				P. K. Morley-Forster, S. Singh, P. Angle, J. Littleford, M. Currin, and S. H. Halpern The effect of epidural needle type on postdural puncture headache: a randomized trial: [L'effet du type d'aiguille de peridurale sur les cephalees post-ponction durale : une etude randomisee]. Can J Anesth, June 1, 2006; 53(6): 572 - 578. [Abstract] [Full Text] [PDF]

				A. Y.C. Wong Is PDPH from a 25-gauge Whitacre needle always short-lasting and self-resolving? Can J Anesth, June 1, 2004; 51(6): 637 - 637. [Full Text] [PDF]

				D. K. Turnbull and D. B. Shepherd Post-dural puncture headache: pathogenesis, prevention and treatment Br. J. Anaesth., November 1, 2003; 91(5): 718 - 729. [Abstract] [Full Text] [PDF]

				J. S. Lee, D. H. Bremerich, and D. Meininger Does Intrathecal Mepivacaine Cause Post Lumbar Puncture Headache? * Response Anesth. Analg., September 1, 2003; 97(3): 926 - 927. [Full Text] [PDF]

				P. T. Choi, S. E. Galinski, L. Takeuchi, S. Lucas, C. Tamayo, and A. R. Jadad PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies: [Les cephalees post-ponction durale sont une complication courante du bloc neuraxial chez les parturientes : une meta-analyse d'etudes obstetricales] Can J Anesth, May 1, 2003; 50(5): 460 - 469. [Abstract] [Full Text] [PDF]

				K. Hamandi, J. Mottershead, T. Lewis, I. C. Ormerod, and I. T. Ferguson Irreversible damage to the spinal cord following spinal anesthesia Neurology, August 27, 2002; 59(4): 624 - 626. [Abstract] [Full Text] [PDF]

				P. H. Pan, R. Fragneto, C. Moore, V. Ross, and G. Justis The incidence of failed spinal anesthesia, postdural puncture headache and backache is similar with Atraucan and Whitacre spinal needles Can J Anesth, June 1, 2002; 49(6): 636 - 637. [Full Text]

				C. M. Heard, J. E. Fletcher, M. C. Vallejo, G. L. Mandell, and S. Ramanathan Is it Ethically Correct to Study the Quincke Spinal Needle in Obstetric Patients? Response Anesth. Analg., January 1, 2002; 94(1): 233 - 234. [Full Text] [PDF]

				R. J. Chilvers, J. Bamber, M. C. Vallejo, S. Ramanathan, J.-Y. Dupuis, G. Godet, S. Gupta, B. Singh, N. Kachru, H. Yuasa, et al. Postdural Puncture Headache in Obstetric Patients Response Anesth. Analg., June 1, 2001; 92(6): 1616 - 1616. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999