Spinal anaesthesia in young patients: evaluation of needle gauge and design on technical problems and postdural puncture headache

Background:The well-known complication of spinal anaesthesia, postdural puncture headache (PDPH), is especially troublesome in young patients. The needle gauge and configuration of needle tip appear to be the important factors in reducing the incidence of PDPH; however it may increase the incidence of technical problems. Objective: To evaluate the role of 25 and 27 gauge Quincke and Whitacre spinal needles on technical difficulties and incidence of PDPH in patients between 16 and 40 years of age. Methods: Eight hundred patients receiving spinal anaesthesia for urological surgery were divided into four groups of 200 each according to spinal needle used. Group Q-25 and group Q-27 received spinal anaesthesia with 25 gauge and 27 gauge Quincke needles whereas in group W-25 and group W-27, 25 gauge and 27 gauge Whitacre needles were used. The parameters observed were technical problems in terms of number of attempts, failure rate, time to cerebrospinal fluid (CSF) detection and incidence and severity of PDPH. Results: Subarachnoid space was successfully located at first attempt in 92% cases of group Q-25, 89% cases of group W-25, 63.5% cases of group Q-27 and 61% cases of group W-27. Failure rate was 4% in group Q-27 and 7% in group W-27. Time to CSF detection was comparable between group Q-25 and group W-25 and between group Q-27 and group W-27. PDPH was observed in 14% cases of group Q-25 and 7% of cases of group Q-27 respectively. Conclusion: A 25G Whitacre needle seems to be a suitable choice in young patients because of its ease of handling without an introducer and low incidence of PDPH.