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Postdural puncture headache after neuraxial labor analgesia with 25- vs. 27-gauge Whitacre needles: a single-center
M Balot1, G Echevarria1, A Lee1
1Icahn School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai West and Morningside Hospitals, New York, NY, USA.
Background:
Combined spinal epidural (CSE) and dural puncture epidural (DPE) procedures have become increasingly utilized for labor analgesia, though no standards exist on which spinal needle to use. It has been demonstrated that pencil-point needles reduce the rate of postdural puncture headaches; however, there is no consensus on the optimal size to minimize headache risk while maximizing analgesia.
Methods:
A single-center retrospective cohort study was conducted of parturients receiving CSE or DPE for neuraxial labor analgesia between 2018 and 2023 to identify the postdural puncture headache rate with intended (but not unintended) dural puncture.
Results:
A total of 10,459 CSE and DPE procedures were performed during the study period, with CSE most commonly performed (91%). For CSE, 27G needle was used in 69% of cases, and for DPE, 25G needle was used in nearly two-thirds of cases. Fifty-four patients (0.52%) experienced a postdural puncture headache (without evidence of unintended dural puncture with epidural needle). Postdural puncture headache occurred more frequently with 25G needles than with 27G needles (0.73% vs. 0.41%), corresponding to a risk ratio of 0.56 (95% CI 0.34-0.92; P=0.029)).
Conclusions:
There was a small but statistically significant increase in the incidence of postdural puncture headache when comparing rates with use of 25G vs. 27G needles during CSE or DPE. However, the clinical significance of this modest increase must be weighed against the potential benefit of improved analgesia with the use of larger-gauge (25G) pencil-point spinal needles.
