Skip to main content
Download PDF

Postdural puncture headache: a randomized prospective comparison of the 24 gauge Sprotte and the 27 gauge Quincke needles in young patients

Canadian Journal of Anaesthesia volume 40, pages 607–611 (1993)Cite this article

Abstract

This study was designed to compare the frequency of postdural puncture headaches (PDPH) using the 24 gauge Sprotte and the 27 gauge Quincke spinal needles in a population of patients less than 45 yr of age undergoing spinal anaesthesia for nonobstetrical surgery. Patients were randomly assigned to receive spinal anaesthesia with either the 24 gauge Sprotte spinal needle (n = 46) or the 27 gauge Quincke spinal needle (n = 47). Patients were interviewed on either postoperative day one or two and on postoperative day three. A PDPH was defined as a headache involving the occipital or frontal areas that is made worse when assuming either the sitting or standing position. Ninety-three patients were included in the analysis of data. The overall incidence of PDPH was 14% (13 of 93), and no difference was found between the Sprotte (15.2%) and Quincke (12.8%) needles. The distribution of the PDPHs by severity was not different between the two groups. None of the 13 patients with PDPHs required an epidural blood patch for relief of symptoms. Both the Sprotte needle and the Quincke needles were judged as easy to use and both required the same number of attempts in order to locate cerebrospinal fluid (first attempt successful: 73.9% versus 66%). Neither patient satisfaction nor the acceptability of spinal anaesthesia for a future procedure was adversely affected by the occurrence of a PDPH. The results of this study suggest that the risk of PDPH after spinal anaesthesia in young patients is similar using either the 24 gauge Sprotte or the 27 gauge Quincke spinal needle.

Résumé

Cette étude compare la fréquence de la céphalée postrachidienne (CPR) provoquée par l’aiguille 24G Sprotte et Quincke 27G dans une population de patients de moins de 45 ans soumis à une anesthèsie rachidienne pour chirurgie non obstétricale. Les patients sont répartis au hasard de façon à ce qu’on utilise soit l’aiguille rachidienne 24G Sprotte (n = 46), soit l’aiguille rachidienne 27G Quincke (n = 47). On interroge les patients le premier ou le deuxième jour après l’opération, et le troisième jour. Une CPR est définie comme une céphalée occipitale ou frontale aggravée par le position assise ou debout. Les données de 93 patients sont analysées. L’incidence totale des CPR est de 14% (13 de 93) et on ne trouve pas de différence entre l’aiguille Sprotte (15,2%) et l’aiguille Quincke (12,8%). La sévérité de la CPR n’est pas différente entre les deux groupes. Dans aucun des 13 cas de CPR, il n’est nécessaire de colmater avec du sang autologue. On juge les aiguilles Sprotte et Quincke faciles à utiliser et un nombre identique d’essais est requis pour ponctionner la dure-mère (succès au premier essai 73,9% vs 66%). Le degré de satisfaction et d’acceptabilité n’ont pas été affectés par l’apparition de CPR. Les résultats de cette étude suggèrent que le risque de CPR après anesthèsie rachidienne chez des jeunes patients est identique avec les deux auguilles rachidiennes utilisées, la Sprotte 24G et la Quincke 27G.

References

  1. Flanagan JF, Kumatta D, Black D. Comparison of 24 gauge Sprotte and 27 gauge Quincke needle on the incidence of post durai puncture headache. Anesth Analg 1991; 72: S75.

    Google Scholar 

  2. Kang SB, Goodnough DE, Lee YK, et al. Comparison of 26- and 27-G needles for spinal anesthesia for ambulatory surgery patients. Anesthesiology 1992; 76: 734–8.

    PubMed  Article  CAS  Google Scholar 

  3. Hurley RJ, Hertwig LM, Lambert DH. Incidence of post durai puncture headache in the obstetrical patient: 25 gauge Whitacre vs 26 and 27 gauge Quincke tip needles. Reg Anesth 1992; 17: S33.

    Google Scholar 

  4. Mayer DC, Quance D, Weeks SK. Headache after spinal anesthesia for Cesarean section: a comparion of the 27-gauge Quincke and 24-gauge Sprotte needles. Anesth Analg 1992; 75: 377–80.

    PubMed  Article  CAS  Google Scholar 

  5. Coté S, Socci M, Wiesel S. Spinal anaesthesia with the 27 gauge needle. Can J Anaesth 1991; 38: A46.

    Google Scholar 

  6. Sprotte G, Schedel R, Pajunk H. Eine“atraumatische” Universalkanule fur einzeitige Regionalanaesthesien. Reg Anaesth 1987; 10: 104–8.

    PubMed  CAS  Google Scholar 

  7. Tarkkila PJ, Heine H, Tervo R-R. Comparison of Sprotte and Quincke needles with respect to post durai puncture headache and backache. Reg Anesth 1992; 17: 283–7.

    PubMed  CAS  Google Scholar 

  8. Büttner J, Wresch KP, Klose R. Bietet eine konisch geformte Kanülenspitze Vorteile bei der Spinalanaesthesie? Reg Anaesth 1990; 13: 124–8.

    PubMed  Google Scholar 

  9. Dixon CL. The Sprotte, Whitacre, and Quincke spinal needles. Anesthesiology Review 1991; 18: 42–7.

    PubMed  CAS  Google Scholar 

  10. Crone L-AL, Vogel W. Failed spinal anesthesia with the Sprotte needle (Letter). Anesthesiology 1991; 75: 717–8.

    PubMed  Article  CAS  Google Scholar 

  11. Büttner J, Wresch KP, Klose R. Fewer failed spinal anesthestics with the Sprotte needle (Letter). Anesthesiology 1992; 77: 393.

    Article  Google Scholar 

  12. Vandam LD, Dripps RD. Long-term follow-up of patients who received 10,098 spinal anaesthetics. JAMA 1956; 161: 586–91.

    CAS  Google Scholar 

  13. Flaatten H, Rodt S, Rosland J, Vamnes J. Postoperative headache in young patients after spinal anaesthesia. Anaesthesia 1987; 42: 202–5.

    PubMed  Article  CAS  Google Scholar 

  14. Lybecker H, Mϕller JT, May O, Nielsen HK. Incidence and prediction of postdural puncture headache. A prospective study of 1021 spinal anesthetics. Anesth Analg 1990; 70: 389–94.

    PubMed  Article  CAS  Google Scholar 

  15. Sarma VJ, Boström U. Intrathecal anaesthesia for day-care surgery. A retrospective study of 160 cases using 25- and 26-gauge spinal needles. Anaesthesia 1990; 45: 769–71.

    PubMed  Article  CAS  Google Scholar 

  16. Driessen A, Mauer W, Fricke M, Kossmann B, Schleinzer W. Prospective studies on the pathologic mechanism of post-spinal headache in a select group of patients. Anaesthetist 1980; 29: 38–41.

    CAS  Google Scholar 

  17. Crawford JS. Experience with spinal analgesia in a British obstetric unit. Br J Anaesth 1979; 51: 531–5.

    PubMed  Article  CAS  Google Scholar 

  18. Flaatten H, Raeder J. Spinal anaesthesia for outpatient surgery. Anaesthesia 1985; 40: 1108–11.

    PubMed  Article  CAS  Google Scholar 

  19. Barker P. Are obstetric spinal headaches avoidable? Anaesth Intensive Care 1990; 18: 553–4.

    PubMed  CAS  Google Scholar 

  20. Guerts JW, Haanschoten MC, van Wijk RM, Kraak H, Besse TC. Post-dural puncture headache in young patients. A comparitive study between the use of 0.52 mm (25-gauge) and 0.33 mm (29-gauge) spinal needles. Acta Anaesthesiol Scand 1990; 34: 350–3.

    Google Scholar 

  21. Rasmussen BS, Blom L, Hansen P, Mikkelsen SS. Postspinal headache in young and elderly patients. Two randomised, double-blind studies that compare 20-and 25-gauge needles. Anaesthesia 1989; 44: 571–3.

    PubMed  Article  CAS  Google Scholar 

  22. Cesarini M, Torrielli R, Lahaye F, Mene JM, Cabiro C. Sprotte needle for intrathecal anaesthesia for Caesarean section: incidence of postdural puncture headache. Anaesthesia 1990; 45: 656–8.

    PubMed  Article  CAS  Google Scholar 

  23. Abboud TK, Zhu J, Reyes A, et al. Effect of subarachnoid morphine on the incidence of spinal headache. Reg Anesth 1992; 17: 34–6.

    PubMed  CAS  Google Scholar 

  24. Dittmann M, Renkl F. Spinal anesthesia with extremely fine needles (Letter). Anesthesiology 1989; 70: 1035–6.

    Article  Google Scholar 

  25. Flaatten H, Rodt SA, Vamnes J, Rosland J, Wisborg T, Koller ME. Postdural puncture headache: a comparison between 26- and 29-gauge needles in young patients. Anaesthesia 1989; 44: 147–9.

    PubMed  Article  CAS  Google Scholar 

  26. Naulty JS, Hertwig L, Hunt CO, Datta S, Ostheimer GW, Weiss JB. Influence of local anesthetic solution on postdural puncture headache. Anesthesiology 1990; 72: 450–4.

    PubMed  Article  CAS  Google Scholar 

  27. Quaynor H, Corbey M, Berg P. Spinal anaesthesia in daycare surgery with a 26-gauge needle. Br J Anaesth 1990; 65: 766–9.

    PubMed  Article  CAS  Google Scholar 

  28. Dahl JB, Schultz P, Anker-Mϕller E, Christensen EF, Staunstrup HG, Carlsson P. Spinal anaesthesia in young patients using a 29-gauge needle: technical considerations and an evaluation of postoperative complaints compared with general anaesthesia. Br J Anaesth 1990; 64: 178–82.

    PubMed  Article  CAS  Google Scholar 

  29. Lynch J, Arhelger S, Krings-Ernst I. Post-dural puncture headache in young orthopaedic in-patients: comparison of a 0.33 mm (29-gauge) Quincke-type with a 0.7 mm (22-gauge) Whitacre spinal needle in 200 patients. Acta Anaesthesiol Scand 1992; 36: 58–61.

    PubMed  CAS  Google Scholar 

  30. Mihic DN. Postspinal headache and relationship of needle bevel to longitudinal durai fibers. Reg Anesth 1985; 10: 76–81.

    Google Scholar 

  31. Johnson MD, Hertwig L, Vehring PH. Datta S. Intrathecal fentanyl may reduce the incidence of spinal headache. Anesthesiology 1989; 71: A911.

    Article  Google Scholar 

  32. Kaplan G. The psychogenic etiology of headache post lumbar puncture. Psychosom Med 1967; 29: 376–9.

    PubMed  CAS  Google Scholar 

  33. Daniels AM, Sallie R. Headache, lumbar puncture, and expectation (Letter). Lancet 1981; 1: 1003.

    PubMed  Article  CAS  Google Scholar 

  34. Gielen M. Post durai puncture headache (PDPH): a review. Reg Anesth 1989; 14: 101–6.

    PubMed  CAS  Google Scholar 

  35. Lambert DH. Complications of spinal anesthesia. Int Anesthesiol Clin 1989; 27: 51–5.

    PubMed  CAS  Article  Google Scholar 

  36. Gerard KW, Fagraeus L. Postspinal headache. Seminars in Anesthesia 1990; 9: 69–74.

    Google Scholar 

  37. Weeks SK. Spinal headache — prevention and treatment. Can J Anaesth 1990; 37: S53–8.

    Article  Google Scholar 

  38. Cambell DC. Douglas MJ, Pavy TJC, Flanagan ML, McMorland GH. Comparison of 25G Whitacre vs 24G Sprotte needles for Caesarean section. Can J Anaesth 1992; 39: A46.

    Google Scholar 

  39. Devcic A, Sprung J, Maitra-D’Cruze A, Haddox JD. Post-dural puncture headache in an obstetric population: comparison of 24-ga Sprotte and 25-ga Quincke needles. Reg Anesth 1992; 17: S69.

    Google Scholar 

  40. Ross BK, Chadwick HS, Mancuso JJ, Benedetti C. Sprotte needle for obstetric anesthesia: decreased incidence of post durai puncture headache. Reg Anesth 1992; 17: 29–33.

    PubMed  CAS  Google Scholar 

  41. Schneider M, Schuhmacher P, Kaufmann M. Incidence of postdural puncture headache (PDPH) in young pregnant and nonpregnant women after spinal anesthesia with a 24G Sprotte needle. Reg Anesth 1992; 17: S93.

    Google Scholar 

  42. Norris MC, Leighton BL, DeSimone CA. Needle bevel direction and headache after inadvertant dural puncture. Anesthesiology 1989; 70: 729–31.

    PubMed  Article  CAS  Google Scholar 

  43. Ready LB, Cuplin S, Haschke RH, Nessly M. Spinal needle determinants of rate of transdermal fluid leak. Anesth Analg 1989; 69: 457–60.

    PubMed  Article  CAS  Google Scholar 

  44. Fennelly M, Galletly DC, Purdie GI. Is caffeine withdrawal the mechanism of postoperative headache? Anesth Analg 1991; 72: 449–53.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Anaesthesia, Sir Mortimer B. Davis-Jewish General Hospital and McGill University, Montreal, Canada

    Saul Wiesel, Michael J. Tessler & L. Jane Easdown

Authors
  1. Saul Wiesel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael J. Tessler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Jane Easdown
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wiesel, S., Tessler, M.J. & Easdown, L.J. Postdural puncture headache: a randomized prospective comparison of the 24 gauge Sprotte and the 27 gauge Quincke needles in young patients. Can J Anaesth 40, 607–611 (1993). https://doi.org/10.1007/BF03009696

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03009696

Key words

  • anaesthetic techniques: spinal
  • complications: headache