Incidence and Severity of Postdural Puncture Headache following Subarachanoid Block using 25G Quincke and 25G Whitacre Spinal Needles: A Double-blinded, Randomised Control Study

Abstract

Introduction: Postdural Puncture Headache (PDPH) is the most common complication of dural puncture. Clinical studies have shown that use of small guage needles with pencil point tip is associated with lower incidence and severity of PDPH than with cutting tip needles. Aim: To compare the incidence and severity of PDPH between 25G cutting (Quincke) and 25G non cutting (Whitacre) needles. Materials and Methods: In this randomised controlled study conducted at Jawaharlal Nehru Institute of Medical SciencesImphal, Manipur, India from September 2019 to September 2021. A total of 150 patients of both sexes, age <60 years and American Society of Anaesthesiologists (ASA) grade I and II, undergoing lower abdominal or lower limb surgeries under spinal anaesthesia were enrolled for this study and divided into two groups with 75 patients in each group. Spinal anaesthesia was performed with 25G Quincke needle in one group and 25G Whitacre needle used in other group to compare the incidence and severity of PDPH (severity was determined by limitation of patient activity and treatment required). Results: Overall 14 patients (9.33%) developed PDPH – 2 in the Whitacre spinal needle (2.6%), and 12 in the Quincke spinal needle (16%), with p-value of 0.009. The incidence of failed spinal anaesthesia was significantly higher with Whitacre spinal needle 12 (16%) than with Quincke needle 4 (5.3%), with p-value of 0.03. Incidence of PDPH was more in female patients 12 (14.8%) compared with male patients 2 (2.9%),with p-value of 0.018. Severity of PDPH ranged from mild (n=10) to moderate (n=2) in Quincke needle group, whereas in Whitacre group patients had only mild form of PDPH (n=2). Conclusion: Incidence and severity of PDPH was significantly lower in 25G Whitacre spinal needle than 25G Quincke needle. Failure rate of spinal anaesthesia was more in Whitacre needle than in Quincke needle.

Comparison of 25 G Whitacre and Quincke Spinal Needles for Incidence of Post-Dural Puncture Headache

“…Overall, 15.7% females had headache. A previous study also reported that 11.1% females and 3.7% males had PDPH (BALUSAMY et al, 2022). A study on mechanism and management of failed spinal anesthesia reported that pencil point needle leads to partial loss of anesthetic solution in subdural and epidural space (Tiak and Zahari, 2023).…”

“…One of these disadvantages is post-dural puncture headache (PDPH), which results in distressing complications. PDPH is a bilateral throbbing headache associated with the position, and its severity varies (BALUSAMY et al, 2022). Various studies reported that the incidence of PDPH ranges from 0 to 37.3% (Khan et al, 2020).…”

“…It is associated with blurred vision, hearing disturbances, vertigo, vomiting, and nausea. Its pathophysiology includes loss of cerebrospinal fluid, which results in pain as the brain sags, resulting in intracerebral vasodilation in response to reduced intracranial pressure (Al-Hashel et al, 2022). Its risk factors include lower BMI, female gender, younger age, pregnancy, type of needle, and its larger size (Bein and Renner, 2019).…”