The effect of the spinal needle tip design on the incidence of postdural puncture headache: A randomized double-blind study on 200 obstetic patients

ABSTRACT

BACKGROUND: A myriad of foreign studies have shown the advantage of a pencil-point spinal needle (Whitacre) in reducing the incidence of post-ducal puncture headache (PDPH), especially in the population most at risk for PDPH - the obstetric patients. In the Philippines, there has been no data comparing the incidence of PDPH between the standard spinal needle (Quincke) and the newer Whitacre needle. This study aims to compare the incidence of spinal headache between the Quincke and the Whitacre spinal needle in Filipino obstetric patients. METHODS: A randomized double-blind study was conducted on 200 obstetric patients for elective cesarean sections under subarachnoid anesthesia using either a Quincke or a Whitacre spinal needle of the same gauge (G25). The incidence and quality of post-ducal puncture headache was compared between the two groups. Both groups were also compared in terms of ease of lumbar puncture, quality of motor block, and the incidence of postoperative complications RESULTS: The incidence of PDPH was significantly higher in the Quincke group (8 percent) as compared to the Whitacre group (1 percent). The case of insertion of the spinal needle was considered effortless (1 attempt) in 67 percent of the Quincke group and in 61 percent of the Whitacre group. Degree of motor blockade was noted to be more solid in the Whitacre group (93 percent) as compared to 83 percent in the Quincke group. There were 2 failed spinal attempts in the Quincke group and 3 in the Whitacre group for which general anesthesia was resorted to. Other postoperative complications of non-spinal headache (Quincke- 4 percent vs. Whitacre- 3 percent) and backache or back soreness as specified by the patients (Quincke 12 percent vs Whitacre 15 percent) did not differ significantly. CONCLUSION: Results imply that the G25 Whitacre needle with a conical, non-cutting bevel is an improved alternative to the G25 Quincke needle in terms of reducing the incidence and quality of postdural puncture headache in Filipino obstetric patients. The design of the spinal needle tip influences the occurrence of PDPH. (Author)