Background: Spinal anesthesia is relatively a safe procedure compared to general anesthesia. It provides good muscle relaxation and avoids fetal as well as maternal risks of general anesthesia. Requires minimum postoperative anesthesia care and provides adequate post - operative analgesia. But one of the limiting factors in the use of spinal anesthesia has been the occurrence of post-dural puncture headache. Its incidence is highest in obstetric patients. There are some attempts to reduce the incidence of this complication.

Aim: To compare the incidence of post-dural puncture headache using 23G,25G quincke and, 23G,25G whitacre needle in patient undergoing elective  caesarean section.

Materials and Methods: A prospective comparative study of 100 parturients who were selected randomly from the age group of 20-45 years having a pregnancy of at least 34 weeks gestation with a single uncompromised fetus and uncomplicated pregnancy. The parturients were divided into four groups of 25 patients each. Group I and Group II Patients who received spinal anesthesia with 23G and 25G quincke needle where as Group III and IV received with 23G and 25G Whitacre needle respectively, using 0.5% heavy bupivacaine10mg (2ml).

Results: There were no significant differences between groups in all demographic data. Three patients in group I with 23G Quincke (12%), two patient in group II with 25G Quincke (8%), one patient in group III with 23G Whitacre (4%) developed post dural puncture headache and patients in group IV with 25G Whitacre spinal needles had no headache. Post dural puncture headache was statistically compared between group I and group II, group II and group III, group III and group IV and group I and group IV using Chi-square test. The values were 0.632, 0.552, 0.312 and 0.074 respectively.. The values in the study were statistically not significant but clinically relevant.

Conclusion: Use of Whitacre needle was associated with reduced incidence of post-dural puncture headache in our study. It is technically difficult to introduce 25G Whitacre needle. There is a high degree of acceptance on part of the patient with the use of Whitacre needles. 23G and 25G Whitacre needle are associated with low incidence of post dural Puncture headache.

Keywords: Quincke needle, Whitacre needle, Postdural puncture headache, spinal anaesthesia.

1. Krueger, J.E., Stoelting, V.K. and Graf, J.P.; “Etiology and treatment of postspinal headaches”. Anesthesiology 1951; 12: 477-85.
2. Vandam, L.D. and Dripps, R.D.; “Long term follow-up of patients who received 10,098 spinal anesthetics. Syndrome of decreased intracranial pressure (headache and ocular and auditory difficulties)”. Journal of the American Medical Association 1956; 161: 586-91.
3. Post dural puncture headache(PDPH) and associated factors after spinal anesthesia among patient in the University of Gondar Referral and Teaching Hospital, Gondar, North West Kassa AA, Beyen TK, Denu ZA(2015).J Anesth clin Res 6:536. Doi:10.4172/2155-6148. 1000536.
4. Rasmussen, B.S., Blom, L., Hansen, P. and Mikkelsen; "Post spinal headache in young and elderly patients. Two randomized double-blind studies that compare 20 and 25 gauge needles". Anaesthseia, 44: 571, 1989.
5. Krueger, J.E., Stoelting, V.K. and Graf, J.P.; “Etiology and treatment of post-spinal headaches". Anesthesiology 1951; 12:477-85.
6. Vandam, L.D. and Dripps, R.D.; “Long term follow-up of patients who received 10,098 spinal anesthetics. Syndrome of decreased intracranial pressure (headache and ocular and auditory difficulties)”. Journal of the American Medical Association 1956; 161: 586-91.
7. Shutt, L.E., Valentine, S.J., Wee, M.Y.K., Page, R,J., Prosser, A. and Thomas, T.A.; “Spinal anaesthesia for Caesarean section – Comparison of 22 gauge and 25 gauge Whitacre needle with 26 gauge Quincke needles”. Br. J. Anaesth 69: 589, 1992.
8. Flatten, H. And Reader,J.; “Spinal anaesthesia for outpatient surgery”. Anaesthesia, 40: 1108, 1985.
9. Kaukinen, S., Kaukinen, L., Kannisto, K. and Kataja, M,; “The prevention of headache following spinal anaesthesia”. Ann Chir Gynaecol 191; 70: 107-11
10. Hwang, J.J., Ho, S.T., Wang, J.J. and Lier, H.S. et al; “PDPH in Caesarean section. Comparison of 25 gauge Whitacre with 25 and 26 G Quincke needle”. Acta. Anaesthesiol. Sin. 35(1): 33-37, 1997.
11. Lynch, J., Krings-Earnst, I., Strick, K., Topalidis, K., Schaaf, H. and Fieblg, M.; “Use of a 25 gauge Whitacre needle to reduce the incidence of post dural puncture headache”. Br.J. Anaesth. 67:690, 1991.
12. Jones, R, “The role of recumbency in the prevention and treatment of post-spinal headache". Anesthesia and analgesia, 53: 788, 1974.
13. Hafer, J., Rupp, D., Woller, UCK M., Engel, J. and Hemplemenn G; "The effect of needle type and immobilization on post-spinal headache". Anesthetist, 46(10): 860, 1997.
14. Cappe B.E. and Park, N.M.; "Prevention of post-spinal headache with a 22 gauge pencil-point needle and adequate hydration". Anesthesia and analgesia Current researches, 39: 463-65, 1960.

Dr Chiranjeevi Nellore, MD (Anesthesiology), PDCC, IDCCM, EDIC.

Assistant Professor, Dept of Anesthesia and Critical Care, Sri Venkateswara Medical College, Tirupati, AP, India