Efficacy of different size Quincke spinal needles in reduction of incidence of Post-Dural Puncture Headache (PDPH) in Caesarean Section (CS). Randomized controlled study

Background
Regional analgesia first introduced in clinical practice by the German surgeon Karl August Bier (1898). Spinal, epidural or combined spinal and epidural anaesthesia became the first line of choice in obstetric surgery. PDPH was found to be more frequent after Caesarean Section in young parturients. Also PDPH is related to CSF leakage from the subarachnoid space.
Objectives
This prospective, double blinded, randomized study compares the frequency of PDPH following spinal anaesthesia for CS and technique difficulty with 22G, 25G and 29G Quincke needles.
Methods
One hundred and eighty ASA I and II full term pregnant females aged 20–40 years, scheduled to receive spinal anaesthesia for elective CS, were randomly divided into three equal groups (n = 60 each). Each group received spinal anaesthesia with 22G (GI), 25G (GII) and 29G (GIII) Quincke needle. Difficulty in localizing the subarachnoid space and time taken to administer spinal anaesthesia were noted. Post-operatively; incidence, onset, site, duration and severity of headache were also studied.
Results
PDPH occurred in 19 patients (31.7%) in GI, 7 patients (11.7%) in GII and 0 patients in GIII. However, the time taken to get CSF from onset of needle insertion was significantly different between the three groups; {13.6(5.2), 28.7(11.1) and 113.5(27.4) sec. mean(SD) in GI, GII and GIII} respectively. The duration of local anaesthetic injection through the spinal needles was significantly different between the three groups; {9.3(0.6), 15.3(1.2) and 37.4(1.7) sec. mean(SD); GI, GII and GIII} respectively. Also time to reach T4 block was significantly longer in GIII when compared with other groups; {5.7(0.8), 5.7(1.1) and 8.0(0.7) min. mean(SD); GI, GII and GIII} respectively. P < 0.05. Conclusion: Spinal anaesthesia with a 29G needle reduced the incidence of PDPH in elective CS to 0%. However, it is significantly more time consuming to give spinal anaesthesia with 29G needle than with the other needles.