Dh. Lambert et al., ROLE OF NEEDLE GAUGE AND TIP CONFIGURATION IN THE PRODUCTION OF LUMBAR PUNCTURE HEADACHE, Regional anesthesia, 22(1), 1997, pp. 66-72
Background and Objectives. Postdural puncture headache (PDPH) is a mor
bidity that occurs frequently after lumbar puncture. The purpose of th
is study was to evaluate the role of needle diameter and tip configura
tion in causing PDPH. The incidence of PDPH was evaluated in parturien
ts because this group of patients is at high risk for developing PDPH
and because they often undergo lumbar puncture for spinal anesthesia.
Methods. The incidence of PDPH after spinal anesthesia with 26- and 27
-gauge Quincke and 25-gauge Whitacre needles was studied in a series o
f 4, 125 parturients undergoing spinal anesthesia over a 4-year period
. Data were also collected on the incidence of PDPH with 17-gauge Hube
r-tipped Weiss needles in 21,578 parturients receiving lumbar epidural
analgesia and/or anesthesia over the same interval. Additionally, the
need to treat PDPH with epidural blood patch in all of these patients
was studied. Results. The incidence of PDPH was 5.2% with 26-gauge Qu
incke needles (1987-1989), 2.7% with 27-gauge Quincke needles (1989-19
90), and 1.2% with 25-gauge Whitacre needles (1990-1991). During the s
ame periods, the incidence of PDPH with 17-gauge Weiss needles average
d 1.1%, 1.7% and 1.2%, respectively. As compared with the 26-gauge Qui
ncke needle, there was a lower incidence of PDPH with the 27-gauge Qui
ncke (P < .006) and 25-gauge Whitacre spinal needles (P < .001). The i
ncidence of PDPH with the 25-gauge Whitacre needle was less than that
with the 27-gauge Quincke needle (P < .05), and it was similar to the
overall rate of headache, which occurs occasionally from accidental du
ral puncture during the performance of lumbar epidural analgesia/anest
hesia for labor and cesarean delivery (P = .974). The need for treatin
g PDPH with epidural blood patching was greatest with the 17-gauge Wei
ss epidural needle (75.3% of cases), hut was similar with the various
spinal needles (13-39%). However, because the Whitacre needle produced
the fewest PDPHs, it was associated with the lowest absolute requirem
ent for epidural blood patching. Conclusions. The morbidity associated
with lumbar puncture can be decreased by selecting the proper needle
gauge and tip configuration. Use of the smallest gauge needle and one
that has a noncutting Whitacre tip produces the lowest incidence of PD
PH in parturients, a group of patients at increased risk for developin
g PDPH.