RESUMEN
To compare the frequency and severity of post dural puncture headache in obstetric patients using 25G Quincke, 27G Quincke and 27G Whitacre spinal needles. Comparative, randomized, double-blind, interventional study. Liaquat University Hospital Hyderabad from October 2005 to December 2006. 480 ASA I-II full term pregnant women, 18 to 45 years of age, scheduled for elective Caesarean section, under spinal anaesthesia, were randomized into three groups: Group I [25G Quincke spinal needle: n=168], Group II [27G Quincke spinal needle: n=160] and Group III [27G Whitacre spinal needle: n=152]. Spinal anaesthesia was performed with 1.5-2.0 ml 0.75% hyperbaric bupivacaine using 25G Quincke spinal needle [Group I], 27G Quincke spinal needle [Group II] and 27G Whitacre spinal needle [Group III] at L3-4 inter-vertebral space. Each patient was assessed daily for four consecutive days following Caesarean section. Frequency and severity and of postdural puncture headache [PDPH] were recorded. Data were analyzed using SPSS-11. Frequency of PDPH following the use of 25G Quincke [Group I], 27G Quincke [Group II] and 27G Whitacre [Group III] spinal needles was 8.3% [14/168], 3.8% [6/160] and 2.0% [3/152] respectively. In Group I, PDPH was mild in 5 patients, moderate in 7 patients and severe in 2 patients. In Group II, it was mild in 2, moderate in 3 and severe in 1 patient. In group III, it was mild in 2 and moderate in 1 patient. Severe PDPH did not occur in Group III. Most of the patients with PDPH developed it on first and second postoperative day. When using a 27G Whitacre spinal needle, the frequency and severity of PDPH was significantly lower than when a 25G Quincke or 27G Quincke needle was used