Postdural puncture headache after spinal anaesthesia in young orthopaedic outpatients using 27-g needles

Purpose: Two large studies reported a very low rate (0.5- 1.8%) of postdura l puncture headache (PDPH) with the use of 27-G spinal needles. We suspecte d that it might be higher in young ambulatory patients. The purpose of this study was to establish the rate prospectively in such a patient population using two types of needles. Methods: Two hundred male and female, outpatients, 18-45 yr, undergoing kne e arthroscopy under spinal anaesthesia were randomly assigned to receive sp inal anaesthesia with hyperbaric lidocaine 5% using either a Quincke or a W hitacre 27-G needle. Twenty patients choosing general anaesthesia formed a comparative group. Using a previously validated questionnaire, the incidenc e and nature of PDPH were evaluated by telephone three to five days after s urgery by an anaesthetist unaware of the anaesthetic technique used. Once a ll data were collected, an anaesthetist not involved in the study determine d in a blinded fashion which headaches were likely to be PDPH. Grading and classification of headaches were based on several criteria: postural nature , duration, intensity and confinement to bed. Results: The overall incidence of PDPH in both spinal groups was 9.3%. The incidence in women, 20.4%, was higher than in men, 5.5%, (P < 0.05). Only o ne patient required a blood patch. Both types of needle were comparable wit h respect to the incidence, severity and duration of PDPH, number of dural punctures and failed spinal blocks. Conclusion: The rate of PDPH was higher than in large published studies wit h 27-G Quincke and Whitacre needles and greater in women than in men.