COMPARISON OF INCIDENCE OF POST-DURAL PUNCTURE HEADACHE BETWEEN 25G AND 27G QUINCKE VARIETY SPINAL NEEDLE IN EMERGENCY CESAREAN SECTION

Abstract

Background: Post-dural puncture headache (PDPH) is a common complication of spinal anesthesia, particularly in obstetric patients undergoing cesarean section. The incidence of PDPH is influenced by multiple factors, among which the size of the spinal needle plays a significant role. Larger gauge needles are associated with increased dural trauma and cerebrospinal fluid leakage, leading to a higher risk of PDPH.

Objective: To compare the incidence of post-dural puncture headache between 25G and 27G Quincke spinal needles in patients undergoing emergency cesarean section and to identify associated risk factors.

Methodology: This prospective comparative study was conducted on 100 patients undergoing emergency cesarean section under spinal anesthesia. Patients were randomly divided into two groups: Group A (n=50) received spinal anesthesia using a 25G Quincke needle, while Group B (n=50) received a 27G Quincke needle. Demographic data, procedural details, intraoperative hemodynamic parameters, and postoperative outcomes were recorded. Patients were followed for up to 5 days to assess the occurrence and characteristics of PDPH. Data were analyzed using appropriate statistical tests, and logistic regression analysis was performed to identify independent predictors.

Results: The overall incidence of PDPH was 14%. A significantly higher incidence was observed in the 25G group (20%) compared to the 27G group (8%) (p ≈ 0.048). Multiple attempts and technical difficulty were significantly associated with increased PDPH incidence. Logistic regression analysis identified the use of 25G needle, more than one attempt, and difficult procedure as independent predictors of PDPH. Most cases of PDPH occurred within 24–48 hours and were mild to moderate in severity. Patient-related factors such as age, weight, and ASA status were not significantly associated with PDPH.

Conclusion: The use of 27G Quincke spinal needle significantly reduces the incidence of post-dural puncture headache compared to the 25G needle in emergency cesarean sections. Procedural factors, particularly number of attempts and technical difficulty, play a crucial role in the development of PDPH. Adoption of smaller gauge needles along with optimized technique can improve patient outcomes and reduce complications in obstetric anesthesia.