Whitacre or Quincke needles - does it really matter

Background: Postdural puncture headache (PDPH) and backache are well known complications of spinal anaesthesia. The incidence of PDPH may be significa nt in young people (<50 years). The present study was undertaken in order t o compare the utility and complication rate of the Whitacre and Ouincke spi nal needles. Methods: During three years all patients who could comply, and who were to undergo spinal anaesthesia at the Department were asked to join this qualit y control study. Each one received a questionnaire including questions abou t discomfort and other possible side effects attributed to spinal anaesthes ia. In each case, an extended anaesthetic record was filled out by the anae sthesiologist. About 50 anaesthesiologists at different educational levels were involved. Results: The study includes 2598 cases, of which questionnaires were return ed by 66%. Needles of the 25 G gauge size were used in over 90% of the case s. Multiple skin punctures were required more frequently in the Quincke tha n in the Whitacre group (P<0.01). The number of insufficient blocks was als o higher in the Quincke group (P<0.01). There was a higher incidence of bac kache in the Quincke group (P<0.05). In patients under 50 years, PDPH was m ore frequent following use of the Quincke needle (P<0.05), whereas no diffe rence between the needles in this regard was found among those over 50 year s (P>0.05). Conclusions: For routine clinical use the Whitacre needle appears to be ass ociated with better performance and increased reliability. In younger patie nts the Whitacre needle have the additional advantage of decreasing the ris k of postdural puncture headache.