Frequency of headache with 25G or 27G quincke needles after spinal anesthesia in patients undergoing elective cesarean section

Abstract

Objectives: Post-dural puncture headache (PDPH) is an iatrogenic complication of spinal anesthesia which results from puncture of the dura mater. The signs and symptoms of PDPH are thought to be caused due to loss of cerebrospinal fluid, traction on the cranial contents and reflex cerebral vasodilation. The patient’s age, sex and the size of the dural perforation are the two most important factors affecting the frequency and severity of PDPH. We aimed to compare the frequency of post-dural puncture headache (PDPH) with 25G quincke needle and 27G quincke needle in spinal anesthesia in patients undergoing elective cesarean section.

Methodology: This randomized controlled trial was carried out in our anesthesiology department over a period of six months from 1st December 2014 to 30th May 2015. A total of 124 parturients, ASA physical status I to II undergoing cesarean section were included in this study. Patients with infection at the site of injection, severe hypovolemia, coagulopathy, raised intracranial pressure, severe aortic and mitral stenosis, severe preeclampsia, placenta previa grade II-IV, placenta accreta and twin pregnancy were excluded from the study. Enrolled parturients were divided into two groups A and B, with 62 patients in each group. In Group-A and Group-B, Quincke spinal needles 25G and 27 G were used respectively to administer spinal anesthesia in the sitting position at the L3-4 or L4-5 intervertebral spaces. PDPH was assessed after 6, 12, 24 and 48 hours of surgery. Qualitative variable are presented as frequency and percentages while quantitative variable like age was presented as mean ± SD. Sample t-test was applied on quantitative variable age.  Chi-square test was applied for comparison of PDPH. A P- value < 0.05 was considered statistically significant.

Results: The ages of patients were between 18 to 40 years. Mean age of the patients in Group-A was 27.77 ± 4.82 y and 27.74 ± 4.30 y in Group-B. Nine patients (14.5%) of Group-A experienced PDPH as compared to 2 patients (3.2%) of Group-B. There was statistically significant difference (p = 0. 027) between the groups.

Conclusion: We conclude that 27G quincke spinal needle has definite advantage over 25G quincke spinal needle in terms of frequency of PDPH in spinal anesthesia for cesarean sections.