Cefalea postpunción dural con aguja espinal de bisel cortante aguja espinal de punta cónica: revisión sistemática / Postdural puncture headache with cutting spinal needle pencil point spinal needle: systematic review

INTRODUCTION: Postdural puncture headache is one of the most frequent complications that occurs after the puncture of the dura mater, resulting in the spinal fluid leakage, through the same and subsequent traction of brain structures. OBJECTIVE: To compare cutting spinal needle and pencil point spinal needle in the incidence of postural dural puncture headache. MATERIALS AND METHODS: A literature search of scientific articles published since 2006 was carried out in the Pubmed, Science Direct, Clinical Key and EBSCO databases, which evaluates the incidence of postdural puncture headache in spinal needles with conical tip and cutting bevel, additionally, experts will be consulted in the area that should suggest literature related to this topic, which would not have been included in the search methods previously described. RESULTS: In total, 14 studies were selected in the population that suffered puncture of the dura mater after accidental, therapeutic or diagnostic lumbar puncture (LP) and the presentation of postdural puncture headache was measured according to the ICHD-3 beta criteria. It was found that there is a decrease in the incidence of postdural puncture headache with conical tip spinal needles, compared to spinal needles of cutting bevel. CONCLUSIONS: Current evidence indicates that postdural puncture headache occurs less frequently, with low intensity and short duration in patients operated with a conical spinal needle, compared to the cutting bevel. In addition, according to the recently described pathophysiology, it is contradictory that conical spinal needles are called "atraumatic", so this review proposes a change in nomenclature that is most useful for the clinical anesthesiologist.

INTRODUCCIÓN: La cefalea postpunción dural es una de las complicaciones más frecuentes que se presenta posterior a la punción de la duramadre, lo cual produce salida de líquido cefalorraquídeo, a través de la misma y posterior tracción de las estructuras cerebrales. OBJETIVO: Comparar la aguja espinal de bisel cortante y la aguja espinal de punta cónica en la incidencia de presentación de cefalea postpunción dural. MATERIALES Y MÉTODOS: Se realizó una búsqueda bibliográfica de artículos científicos publicados desde el año 2006, en las bases de datos Pubmed, Science Direct, Clinical Key y EBSCO, que evaluaran la incidencia de cefalea postpunción dural en agujas espinales de punta cónica y bisel cortante, adicionalmente se consultó con expertos en el área que pudieran sugerir literatura relacionada con este tema, la cual no hubiese sido incluida en los métodos de búsqueda previamente descritos. RESULTADOS: En total se seleccionaron 14 estudios realizados en población que sufrieron punción de la duramadre luego de punción lumbar (PL) accidental, terapéutica o diagnóstica y se midió la presentación de cefalea postpunción dural según los criterios ICHD-3 beta. Se encontró que hay una disminución de la incidencia de cefalea postpunción dural con las agujas espinales de punta cónica, en comparación con las agujas espinales de bisel cortante. CONCLUSIONES: La evidencia actual indica que la cefalea postpunción dural se presenta con menor frecuencia, baja intensidad y corta duración en pacientes intervenidos con aguja espinal de punta cónica, en comparación con la aguja espinal de bisel cortante. Adicionalmente, según la fisiopatologia recientemente descrita, es contradictorio que las agujas espinales de punta cónica sean llamada "atraumáticas", por lo que esta revisión propone un cambio en la nomenclatura que resulta de mayor utilidad para el anestesiólogo clínico.

Cefalea post punción dural en embarazadas sometidas a cesárea con anestesia raquidea ¿problema actual o pasado? / Cefalea post dural puncture in pregnant submissions to caesárea with raquidea anesthesia problem current or past?

Objetivos: Conocer la incidencia de cefaleas postpunción dural (CPPD) en raquianestesia para cesárea y factores de riesgo reconocidos. Efectividad del tratamiento médico y necesidad de parche hemático peridural. Metodología: Estudio prospectivo, descriptivo, con seguimiento postoperatorio por 72 horas de 914 embarazadas que recibieron raquianestesia para cesárea en el Hospital de la Mujer durante 1 año. Datos registrados por anestesiólogo actuante, seguimiento por un residente. Al diagnosticar una CPPD, se instaló tratamiento según protocolo. Resultados: la incidencia de CPPD fue 2,6 casos/ 100 pacientes, 24 en la población estudiada. 66.7%, aparecieron a las 24 horas; 16,7% a las 48 horas. 54,2% mejoraron a las 24 horas, ninguna requirió parche hemático. 86,3% de las punciones fueron con agujan 25 punta de lápiz, 11,2% con 27 punta de lápiz 23 casos de CPPD para la primera y 1 caso para la segunda, no encontrando asociación estadística (p= 0,759). 76,6% fueron punción única, 15,2% 2 punciones, 7% más de 2. 80,7 % cesáreas urgencia, 65,2% en horario diurno. 42% realizadas por anestesiólogos, 54% por residentes. 8,6% tenían antecedente de cefalea y 2,7% antecedente de CPPD; encontrándose asociación estadística entre la primera y CPPD actual (p=0,001) y entre la segunda y la presencia de CPPD (p=0,004). Conclusiones: obtuvimos una incidencia de CPPD de 2,6%, concordante con datos de la literatura; la mayoría apareció a las 24 horas y todas mejoraron con tratamiento médico. Las pacientes con cefalea y CPPD previa presentaron un RR 5,8 y 5,4 respectivamente (IC 95%), no encontrando asociación con otros factores de riesgo.

Objectives: To know the incidence of post-dural puncture headaches (CPPD) in spinal anesthesia for caesarean section and recognized risk factors. Effectiveness of medical treatment and need for an epidural blood patch Methodology: Prospective, descriptive, postoperative follow-up for 72 hours of 914 pregnant women who received spinal anesthesia for cesarean section, Women 's Hospital during one year study. Data recorded by acting anesthesiologist monitoring by a resident. CPPD to diagnose, treatment was installed according to protocol. Results: CPPD incidence was 2.6 cases / 100 patients, 24 in the study population. 66.7% appeared at 24 hours; 16.7% at 48 hours. 54.2% improved within 24 hours, none required blood patch. 86.3% of punctures were 25G tip pen, 11.2% with 27G tip pen, 23 cases of CPPD for the first and 1 case for the second, finding no statistical association (p = 0.759). 76.6% were single puncture, 15.2% two punctures, 7% more than two. 80.7% cesarean urgency, 65.2% in daytime. 42% made by anesthesiologists, 54% by residents. 8.6% had a history of headache and 2.7% history of CPPD; statistical association was found between the first and current CPPD (p = 0.001) and between the second and the presence of CPPD (p = 0.004). Conclusions: We obtained a CPPD incidence of 2.6%, consistent with data from the literature; Most appeared within 24 hours and all improved with medical treatment. Patients with headache and previous PDCH presented RR 5.8 and 5.4 respectively (95% CI), and found no association with other risk factors.

Cerebral venous thrombosis after spinal anesthesia: case report / Trombose venosa cerebral após raquianestesia: relato de caso

Abstract Introduction Cerebral venous thrombosis (CVT) is a rare but serious complication after spinal anesthesia. It is often related to the presence of predisposing factors, such as pregnancy, puerperium, oral contraceptive use, and malignancies. Headache is the most common symptom. We describe a case of a patient who underwent spinal anesthesia and had postoperative headache complicated with CVT. Case report Male patient, 30 years old, ASA 1, who underwent uneventful arthroscopic knee surgery under spinal anesthesia. Forty-eight hours after the procedure, the patient showed frontal, orthostatic headache that improved when positioned supine. Diagnosis of sinusitis was made in the general emergency room, and he received symptomatic medication. In subsequent days, the headache worsened with holocranial location and with little improvement in the supine position. The patient presented with left hemiplegia followed by tonic-clonic seizures. He underwent magnetic resonance venography; diagnosed with CVT. Analysis of procoagulant factors identified the presence of lupus anticoagulant antibody. The patient received anticonvulsants and anticoagulants and was discharged on the eighth day without sequelae. Discussion Any patient presenting with postural headache after spinal anesthesia, which intensifies after a plateau, loses its orthostatic characteristic or become too long, should undergo imaging tests to rule out more serious complications, such as CVT. The loss of cerebrospinal fluid leads to dilation and venous stasis that, coupled with the traction caused by the upright position, can lead to CVT in some patients with prothrombotic conditions.

Resumo Introdução: A trombose venosa cerebral (TVC) é uma complicação rara, mas grave, após raquianestesia. Está frequentemente relacionada com a presença de fatores predisponentes, como gestação, puerpério, uso de contraceptivos orais e doenças malignas. O sintoma mais frequente é a cefaleia. Descrevemos um caso de um paciente submetido à raquianestesia que apresentou cefaleia no período pós-operatório complicada com TVC. Relato de caso: Paciente de 30 anos, ASA 1, submetido à cirurgia de artroscopia de joelho sob raquianestesia, sem intercorrências. Quarenta e oito horas após o procedimento apresentou cefaleia frontal, ortostática, que melhorava com o decúbito. Foi feito diagnóstico de sinusite em pronto socorro geral e recebeu medicação sintomática. Nos dias subsequentes teve pioria da cefaleia, que passou a ter localização holocraniana e mais intensa e com pequena melhora com o decúbito dorsal. Evoluiu com hemiplegia esquerda seguida de convulsões tônico-clônicas generalizadas. Foi submetido à ressonância magnética com venografia que fez o diagnóstico de TVC. A pesquisa para fatores pró-coagulantes identificou a presença de anticorpo lúpico. Recebeu como medicamentos anticonvulsivantes e anticoagulantes e teve alta hospitalar em oito dias, sem sequelas. Discussão: Qualquer paciente que apresente cefaleia postural após uma raquianestesia, e que intensifica após um platô, perca sua característica ortostática ou se torne muito prolongada, deve ser submetido a exames de imagem para excluir complicações mais sérias como a TVC. A perda de líquido cefalorraquidiano leva à dilatação e à estase venosa, que, associadas à tração provocada pela posição ereta, podem, em alguns pacientes com estados protrombóticos, levar à TVC.

Bilateral subdural hematoma secondary to accidental dural puncture / Hematoma subdural bilateral secundário a punção dural acidental / Hematoma subdural bilateral secundario a punción dural accidental

We report the case of a 25-year-old woman, who received epidural analgesia for labor pain and subsequently presented post-dural puncture headache. Conservative treatment was applied and epidural blood patch was performed. In the absence of clinical improvement and due to changes in the postural component of the headache, a brain imaging test was performed showing a bilateral subdural hematoma. The post-dural puncture headache is relatively common, but the lack of response to established medical treatment as well as the change in its characteristics and the presence of neurological deficit, should raise the suspicion of a subdural hematoma, which although is rare, can be lethal if not diagnosed and treated at the right time.

Apresentamos o caso clínico de uma paciente de 25 anos na qual uma técnica peridural foi aplicada durante o trabalho de parto e posteriormente apresentou cefaleia com características de cefaleia pós-punção dural. Foi iniciado tratamento conservador e tampão de sangue peridural. Devido à ausência de melhoria clínica e à mudança do componente postural da cefaleia, decidiu-se fazer um exame de imagem cerebral que demonstrou a presença de hematoma subdural bilateral. A cefaleia pós-punção dural é relativamente frequente, mas a falta de resposta ao tratamento médico instaurado, assim como a mudança em suas características e a presença de foco neurológico, deve levantar a suspeita de presença de um hematoma subdural que, embora infrequente, pode chegar a ser devastador se não for diagnosticado e tratado oportunamente.

Presentamos el caso clínico de una paciente de 25 años de edad, a quien se le realizó una técnica epidural durante el trabajo de parto y posteriormente presentó cefalea con características de cefalea pospunción dural. Se inició tratamiento conservador y se realizó parche hemático epidural. Ante la falta de mejoría clínica y debido al cambio en el componente postural de la cefalea, se decidió realizar una prueba de imagen cerebral que demostró la presencia de hematoma subdural bilateral. La cefalea pospunción dural es relativamente frecuente, pero la falta de respuesta al tratamiento médico instaurado, así como el cambio en sus características y la presencia de focalidad neurológica, deben hacer sospechar la presencia de un hematoma subdural que, aunque infrecuente, puede llegar a ser devastador si no se diagnostica y trata oportunamente.

A reinserção do estilete não afeta a incidência de cefaleia pós-punção dural (CPPD) após raquianestesia / Reinsertion of the stylet does not affect incidence of post dural puncture headaches (PDPH) after spinal anesthesia / La reinserción del estilete no afecta la incidencia de cefalea pos punción dural (CPPD) posteriormente a la raquianestesia

JUSTIFICATIVA E OBJETIVOS: Este estudo foi conduzido para investigar os efeitos da reinserção do estilete em cefaleia pós-punção dural (CPPD) após raquianestesia. MÉTODOS: Foram selecionados para este estudo 630 pacientes submetidos a cirurgia eletiva com raquianestesia. Os pacientes foram randomicamente designados para dois grupos: Grupo A (reinserção do estilete antes da retirada da agulha) e Grupo B (retirada da agulha sem reinserção do estilete). Os pacientes foram observados durante 24 horas no hospital e avaliados quanto à CPPD no terceiro e sétimo dias do estudo. RESULTADOS: No geral, a incidência da CPPD foi de 10,8% (68 pacientes). Trinta e três desses pacientes (10,5%) que estavam no Grupo A e 35 (11,1%) no grupo B tiveram CPPD. Não houve diferença significativa entre os dois grupos em relação à CPPD. CONCLUSÕES: Ao contrário da punção lombar diagnóstica, a reinserção do estilete após raquianestesia com agulhas tipo Quincke de calibre 25 não reduz a incidência de CPPD.

BACKGROUND AND OBJECTIVES: This study was conducted to investigate the effects of reinsertion of the stylet after a spinal anesthesia procedure on the Post Dural Puncture Headache (PDPH). METHODS: We have enrolled into this study 630 patients who were undergoing elective operations with spinal anesthesia and randomized them to Group A (stylet replacement before needle removal) and Group B (needle removal without stylet replacement). These patients were observed for the duration of 24 hours in the hospital and they were checked for PDPH on the 3rd and the 7th day of the study. RESULTS: Overall, the PDPH incidence was at 10.8% (68 patients). Thirty-three of these patients (10.5%) who were in Group A (stylet replacement before needle removal) and the other 35 patients (11.1%) who were in Group B (needle removal without stylet replacement) experienced PDPH. There was no significant difference between the two groups with respect to the PDPH. CONCLUSIONS: In contrary to the diagnostic lumbar puncture, reinsertion of the stylet after spinal anesthesia with 25-gauge Quincke needles does not reduce the incidence of PDPH.

JUSTIFICATIVA Y OBJETIVOS: Este estudio fue hecho para investigar los efectos de la reinserción del estilete en la cefalea pos punción dural (CPPD) después de la raquianestesia. MÉTODOS: Un total de 639 pacientes sometidos a la cirugía electiva con raquianestesia se seleccionaron para este estudio. Los pacientes fueron aleatoriamente designados para dos grupos: Grupo A (reinserción del estilete antes de la retirada de la aguja) y Grupo B (retirada de la aguja sin la reinserción del estilete). Los pacientes fueron observados durante 24 horas en el hospital y evaluados CPPD en el tercero y en el séptimo día del estudio. RESULTADOS: En general, la incidencia de CPPD fue de un 10,8% (68 pacientes). Treinta y tres de ellos (10,5%) que estaban en el Grupo A (reinserción del estilete antes de la retirada de la aguja) y 35 (11,1%) en el grupo B (retirada de la aguja sin la reinserción del estilete) tuvieron CPPD. No hubo diferencia significativa entre los dos grupos con relación a la CPPD. CONCLUSIONES: Al contrario de la punción lumbar diagnóstica, la reinserción del estilete posterior a la raquianestesia con agujas tipo Quincke de calibre 25 no reduce la incidencia de CPPD.

Continuous spinal anesthesia versus combined spinal epidural block for major orthopedic surgery: prospective randomized study / Raquianestesia continua versus bloqueio combinado raqui-peridural para cirurgias ortopédicas de grande porte: estudo prospectivo e aleatório

CONTEXT AND OBJECTIVES: In major orthopedic surgery of the lower limbs, continuous spinal anesthesia (CSA) and combined spinal epidural anesthesia (CSE) are safe and reliable anesthesia methods. In this prospective randomized clinical study, the blockading properties and side effects of CSA were compared with single interspace CSE, among patients scheduled for major hip or knee surgery. DESIGN AND SETTING: Prospective clinical study conducted at the Institute for Regional Anesthesia, Hospital de Base, São José do Rio Preto. METHODS: 240 patients scheduled for hip arthroplasty, knee arthroplasty or femoral fracture treatment were randomly assigned to receive either CSA or CSE. Blockades were performed in the lateral position at the L3-L4 interspace. Puncture success, technical difficulties, paresthesia, highest level of sensory and motor blockade, need for complementary doses of local anesthetic, degree of technical difficulties, cardiocirculatory changes and postdural puncture headache (PDPH) were recorded. At the end of the surgery, the catheter was removed and cerebrospinal fluid leakage was evaluated. RESULTS: Seven patients were excluded (three CSA and four CSE). There was significantly lower incidence of paresthesia in the CSE group. The resultant sensory blockade level was significantly higher with CSE. Complete motor blockade occurred in 110 CSA patients and in 109 CSE patients. Arterial hypotension was observed significantly more often in the CSE group. PDPH was observed in two patients of each group. CONCLUSION: Our results suggest that both CSA and CSE provided good surgical conditions with low incidence of complications. The sensory blockade level and hemodynamic changes were lower with CSA.

CONTEXTO E OBJETIVOS: Em cirurgias ortopédicas de grande porte, a raquianestesia contínua e o bloqueio combinado raqui-peridural são métodos seguros e confiáveis. Neste estudo prospectivo foram comparadas as propriedades e efeitos colaterais da raquianestesia contínua com o bloqueio combinado raqui-peridural de punção única em pacientes programados para cirurgia ortopédica de quadril, joelho e fraturas de fêmur. TIPO DE ESTUDO E LOCAL: Estudo prospectivo, conduzido no Instituto de Anestesia Regional do Hospital de Base de São José do Rio Preto. MÉTODOS: 240 pacientes com cirurgias de quadril, artroplastia de joelho ou correção de fratura de fêmur programadas foram aleatoriamente arrolados para receberem raquianestesia contínua ou bloqueio combinado raqui-peridural (CSE). Os bloqueios foram realizados com o paciente na posição lateral no interespaço L3-L4. O sucesso das punções, dificuldades técnicas, parestesia, nível do bloqueio sensitivo e bloqueio motor, necessidade de doses complementares de anestésico local, grau de dificuldade técnica, alteração cardiociruculatória e cefaléia pós-punção foram registradas. Ao final da cirurgia, o cateter foi retirado e foi avaliado se havia refluxo de líquor. RESULTADOS: Sete pacientes foram excluídos (3 CSA e 4 CSE). Houve uma menor incidência significativa de parestesia no grupo CSA. O nível do bloqueio sensitivo foi significantemente mais alto no grupo CSE. Bloqueio motor completo ocorreu em 110 pacientes do grupo CSA e em 109 do grupo CSE. Hipotensão arterial foi observada significantemente mais freqüente no grupo CSE. Cefaléia pós-punção da dura-máter ocorreu em dois pacientes de cada grupo. CONCLUSÃO: Nossos resultados sugerem que ambas as técnicas provêm boa anestesia cirúrgica com baixa incidência de complicação. O nível do bloqueio sensitivo e as alterações hemodinâmicas foram menores com a raquianestesia contínua (CSA).

A comparison study between newly-designed pencil-point and cutting needles in spinal anesthesia.

OBJECTIVES: The goal of this single blinded randomized study was to compare the use of routine cutting-tip spinal needle and newly-designed pencil-point Pajunk(AE) in terms of success rate, complications and satisfactions in priests undergoing spinal anesthesia for orthopedic, general and urological surgery at Priest Hospital, Thailand. MATERIAL AND METHOD: After Institutional Review Board approval and patients' signed consent, from August 2006 to October 2007, 91 priests were randomly assigned to have 27-gauge Quincke (control group, C) or 25-gauge Pajunk(AE) (study group, S) spinal needles used in their spinal anesthesia. The number of attempts to successful cerebrospinal fluid return and the success rate of the spinal blockade were documented. Postoperatively, an investigator blinded to the study interviewed patients daily. RESULTS: The first-time needling success rate for Quincke was 79% but for Pajunk(AE) only 46%, lower than reported. The incidence of minor complications was small, even there were 2 postoperative dead cases not related to anesthesia. Over 80% of both groups still preferred the same technique and surgeon satisfaction was good to excellent. CONCLUSIONS: The newly-designed, pencil-point spinal needle was another example on the development of more refined towards quality anesthesia. To be cost-effective, it should be selected for patients at risk of CSF leakage-related complications.

Cefalea pospunción dural. Ultraestructura de las lesiones durales y agujas espinales usadas en las punciones lumbares / Post dural puncture cephalea. UItra-structure of the dural lesions and spinal needles used in lumbar punctures

Con el microscopio electrónico de barrido, se examinó la morfología de las lesiones durales y aracnoideas en muestras de saco dura-aracnoideo extraídos de cuerpos humanos recién fallecidos. Después de hacer punciones con agujas Quincke y Whitacre 22-G y 25-G, no se encontraron diferencias estadísticamente significativas entre las áreas de las lesiones durales y aracnoideas. La lesión tenía una morfología diferente con cada aguja. La aguja Whitacre producía una lesión de bordes rotos con gran destrucción de fibras durales, mientras que la aguja "biselada" Quincke causaba una lesión con forma de "U" o "V", como la tapa de una lata, con bordes de corte limpio. La alineación paralela o perpendicular entre el bisel de la punta de la aguja Quincke y el eje del axis no modificaba el área de las lesiones durales y aracnoideas. Se analizó cómo se puede producir cada tipo de lesión y se interpretaron los otros factores que podrían participar. Con la misma técnica se estudiaron agujas espinales nuevas obteniéndose, en cierto porcentaje de éstas, una imagen tridimensional a gran aumento de la fragmentación de puntas, defectos del pulido y existencia de rebabas. Se analizó cómo se pueden alterar las puntas de las agujas al chocar contra el hueso y de qué manera los defectos de estas constituyen otro aspecto de la compleja suma de variables que predisponen a la aparición de una cefalea pospunción dural.

The morphology of dural and arachnoid lesions was electronically scanned, from samples of dura-arachnoid sacs taken from recently deceased human beings. After punctures with Quincke y Whitacre 22-G y 25-G needles, no statistically significant differences were found between the areas of the dural and arachnoid lesions. The lesion had a different morphology with each needle. The Whitacre needle produced a lesion of broken edges with great destruction of the dural fibers, whereas the Quincke "beveled" needle caused a "U" or "V" shaped lesion, like the lid of a can, with clean-cut edges. The parallel or perpendicular alignment between the bevel of the Quincke needle tip and the axis of the axis did not modify the area of the dural and arachnoid lesions. A study was made of how each type of lesion could have come about and of other possible participating factors. The same technique was used to study new spinal needles and, in a certain percentage, a three dimensional image was obtained, showing a great increase in the fragmentation of the tips, burnish defects and the existence of burrs. We also analyzed how hitting against the bone could affect the tips of the needles and how their defects could be another factor in the complex sum of variables that predispose the patient to suffer post dural puncture cephalea.

Com o microscópio eletrônico de varredura, examinou-se a morfologia das lesoes durais e da aracnóide em amostras de saco dural-aracnóideo extraídos de corpos humanos de recem-falecidos. As diferencas entre as áreas das lesoes durais e da aracnóide pós-puncao com agulhas Quincke e Whitacre 22-G e 25-G nao foram estatisticamente significativas, e a morfologia da lesao causada com cada agulha foi diferente. A agulha Whitacre provocou lesao de bordas rompidas com grande destruicao de fibras durais, enquanto a agulha "biselada" Quincke causou lesao com forma de "U" ou "V", como a tampa de uma lata, com bordas de corte limpo. O alinhamento paralelo ou perpendicular do bisel da ponta da agulha Quincke com o eixo do áxis nao modificou a área das lesóes durais e da aracnóide. Foram analisadas as causas de cada tipo de lesao e interpretados outros fatores envolvidos. Utilizando a mesma técnica, avaliaram-se imagens tridimensionais de algumas agulhas espinhais novas tiradas com grande aumento: fragmentacao das pontas, defeitos de polimento e presenca de rebarbas. Avaliou-se também como se modificam as pontas das agulhas ao atingirem o osso e a influência dos defeitos das pontas na complexa soma de variáveis que predispoem o aparecimento de cefaléia pós-puncao dural.

A comparison of 25 gauge Quincke spinal needle with 26 gauge Eldor spinal needle for the elective Caesarian sections: insertion characteristics and complications.

OBJECTIVE: The study was designed to compare the insertion characteristics and incidence of PDPH between 25 gauge Quincke needle and 26 gauge Eldor needle for spinal anaesthesia in elective c/s. METHOD: 60 pregnant women (aged 19-35 yrs and weighing 58 -67 kg) undergoing elective caesarean section were randomized into group A (Quincke spinal needle group) or group B (Eldor spinal needle group). Spinal anaesthesia was performed with 2.9 ml 0.5% heavy bupivacaine using 25 gauge Quincke spinal needle in group A and 26 Gauge Eldor spinal needle in group B. Onset, time of first identification of backflow of CSF, number of attempts, level of sensory and motor blockade, failure of anaesthesia, inadequate anaesthesia and incidence of PDPH were recorded. RESULT: Quincke spinal needle was found easy at insertion, first attempt was successful in 90% of cases, whereas Eldor spinal needle was successful at first attempt in only 60% of cases. Early identification of CSF was seen in Eldor spinal needle group in 3.5 seconds vs. 5.2 seconds in Quincke spinal needle group. Blood mixed CSF was seen in 8 Quincke spinal needle group vs. none in Eldor spinal needle group. Onset was similar between both groups i.e. in 6 minutes. Failure of anaesthesia was none in Eldor spinal needle group vs. 2 in quincke spinal needle group. Height of sensory block achieved was T4 level in 26 parturients,T6 in 1 ,T8 in 1 and no anaesthesia at all in another 2 parturient as compared to T4 level in 29 and T3 in 1 parturient in Eldor spinal needle group. The degree of motor block with the use of Bromage criteria showed a motor score of 1 or 2 in 26 parturients in Quincke spinal needle group vs. same in all cases in Eldor spinal needle group. The total incidence of PDPH was 8.3 % (5 out of 60 parturient) which occurred all in Quincke spinal needle group. 2 parturient who developed severe PDPH required epidural blood patch. CONCLUSION: 26 gauge Eldor spinal needle was found to be better than 25 gauge Quincke spinal needle for caesarian sections to decrease the incidence of PDPH, though not all insertion characteristics were in favour of the Eldor needle.