Postdural puncture headache: comparison of 25-gauge Whitacre and Quincke needles

To evaluate the influence of the shape of the needle tip on postdural puncture headache (PDPH) independent of the needle diameter, a 25-gauge Whitacre and a 25-gauge Quincke needle were compared.

In a prospective, randomized, double-blind fashion, the study was carried out on 400 patients who received spinal anesthesia for operations of the lower extremities. The 25-gauge Whitacre needle (group 1) and the 25-gauge Quincke needle (group 2) were randomly assigned to the patients, 200 in each group. Patients were interviewed postoperatively on days 1, 3, 5, and 7 using a standardized questionnaire. Only postural headache was defined as PDPH. The intensity of both postural and nonpostural headache were quantified using a 4-point rating scale and a visual analog pain scale (VAS). Statistical analysis was performed with parametric and nonparametric tests when appropriate, p < or = 0.05 was considered as significant.

There were no differences in age and sex distribution between the two groups. Significantly more patients in group 2 (8.5%) complained of PDPH than in group 1 (3%, p < or = 0.02). Duration of PDPH ranged from 1-3 days (median: 1) in group 1, and from 1-9 days (median: 3) in group 2. This difference closely approached significance (p = 0.058). The mean maximal intensity of PDPH was comparable in both groups. Severe PDPH occurred only in two patients of group 2. One of them required a blood patch. With respect to the nonpostural headache, no significant differences were seen.

The use of a conical tipped Whitacre needle results in significantly less PDPH compared to a standard Quincke spinal needle of the same size.