Assessment of Post Dural Puncture Headache in Patients Undergoing Caesarean Section: A Comparison between 25 G Quinke V/S Whitacre Needles

Abstract

Background: PDPH (post dural puncture headache) is a common complication of subarachnoid block and results from iatrogenic puncture of the duramater. Size of the dural puncture [1,2], age of the patient,  needle tip designs [2,3], and  number of lumbar puncture attempts [4,5,6] are also responsible for post dural puncture headache. Incidence of PDPH has been reported to be higher in obstetric patients [7]. Aims and Objectives: This study aims at finding the difference in the incidence of PDPH in two different groups of patients undergoing Caesarian section, who have undergone subarachnoid block either with Quinke or Whitacre needles (25 G). Other associated complications were also to be evaluated. Methodology: In this randomised prospective single blind study, 200 patients undergoing Elective Caesarian Section were divided into two groups Q & W (n=100), each to receive subarachnoid block with Quinke needle (25G) and Whitcre Needle (25G) respectively. Assessment of the incidence of postdural puncture headache was done on the 1st, 2nd & 3rd and 5th postoperative days using a standard questionnaire. The presence, severity duration and nature and onset of headache was assessed. Results: The demographic profile was similar in both groups Q & W. The incidence of post dural puncture headache (PDPH) was greater with 25 G Quinke’s needle. The intensity and duration of PDPH was higher in group Q ie in whom Quinkes needle was used. Nausea and vomiting was also greater in group Q. Conclusion: There was a statistically significant decrease in the incidence of postdural puncture headache using conical tipped pencil point 25G Whitacre spinal needle. There was no statistical difference in the onset of PDPH and the accompanying symptoms with the use of Quinke or Whitacre needles.