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Postdural Puncture Headache:: Comparison of 25-Gauge Whitacre and Quincke Needles
  1. Johannes Buettner, M.D.,
  2. Klaus- P. Wresch, M.D. and
  3. Roderich Klose, M.D.*
  1. *From the Department of Anesthesiology and Intensive Care, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Germany.
  1. Address reprint requests to J. Büttner, M.D., Department of Anesthesilogy and Intensive Care, Berufsgenossenschaftliche Unfallklinik, D-6700 Ludwigshafen, Germany.


Background and Objectives. To evaluate the influence of the shape of the needle tip on postdural puncture headache (PDPH) independent of the needle diameter, a 25-gauge Whitacre and a 25-gauge Quincke needle were compared.

Methods. In a prospective, randomized, double-blind fashion, the study was carried out on 400 patients who received spinal anesthesia for operations of the lower extremities. The 25-gauge Whitacre needle (group 1) and the 25-gauge Quincke needle (group 2) were randomly assigned to the patients, 200 in each group. Patients were interviewed postoperatively on days 1, 3, 5, and 7 using a standardized questionnaire. Only postural headache was defined as PDPH. The intensity of both postural and nonpostural headache were quantified using a 4-point rating scale and a visual analog pain scale (VAS). Statistical analysis was performed with parametric and nonparametric tests when appropriate, p ≤ 0.05 was considered as significant.

Results. There were no differences in age and sex distribution between the two groups. Significantly more patients in group 2 (8.5%) complained of PDPH than in group 1 (3%, p ≤ 0.02). Duration of PDPH ranged from 1-3 days (median: 1) in group 1, and from 1-9 days (median: 3) in group 2. This difference closely approached significance ( p = 0.058). The mean maximal intensity of PDPH was comparable in both groups. Severe PDPH occurred only in two patients of group 2. One of them required a blood patch. With respect to the nonpostural headache, no significant differences were seen.

Conclusions. The use of a conical tipped Whitacre needle results in significantly less PDPH compared to a standard Quincke spinal needle of the same size.

  • Postdural puncture headache
  • Whitacre needle
  • spinal anesthesia.

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