POSTDURAL PUNCTURE HEADACHE AND SPINAL NEEDLE DESIGN

Background: Attempts have been made to reduce the incidence of postdur al puncture headache (PDPH) after spinal anesthesia by changing the si ze and design of the needle. We wished to determine whether these stra tegies are effective in reducing PDPH and whether they affect the inci dence of back pain and the failure rate of spinal anesthesia. Methods: The literature was searched for trials comparing noncutting spinal ne edles with cutting needles and larger spinal needles with smaller need les. Trials were included if they were randomized or blinded and if ou tcomes included PDPH, backache, or failure of the method. The pooled o dds ratio for each side effect was computed, and the results were cons idered statistically significant if the 95% confidence interval exclud ed 1. Results: Four hundred fifty articles were identified by title us ing computerized search strategies. Thirty-one abstracts, 25 correspon dences, 44 original articles, and 12 reviews were assessed. There was a reduction in the incidence of PDPH when noncutting spinal needles ra ther than cutting needles were used (P < 0.05), unless the discrepancy in needle size was very large. There also was a reduction in PDPH whe n a small spinal needle was used compared with a large needle of the s ame type (P < 0.05). There was no difference in the incidence of failu re of spinal anesthesia or the incidence of back pain. Conclusions: We conclude that a noncutting needle should be used for patients at high risk for PDPH, and the smallest gauge needle available should be used for all patients.