Vol. 6, Issue 1, Part A (2024)

Introduction: Spinal anesthesia is a standard anesthetic procedure for cesarean section due to rapid onset of dense block, avoidance of intubation or aspiration of gastric contents, avoidance of depressant agents, reduced blood loss, and moreover less procedural failure. Postdural puncture headache (PDPH) remains a well-recognized complication with incidence varying from 0.1% to 36%.

Objective: To assess the Post dural puncture headache following subarachnoid block for caesarean section: A comparision between 25G and 27G Quincke spinal needle.

Methods: The prospective, single blind, randomized study was conducted at Department of Anesthesia, 250 Beded General Hospital, Kurigram, Bangladesh from January to December 2022. Total eighty full term primi-parous women aged within 18-36 years were selected according to the inclusion criteria. They were divided into two group: group A & Group B, and scheduled to receive spinal anesthesia for elective CS. Patients were randomly assigned to receive spinal anesthesia with either 25G spinal needle (group A, n=40) or with 27 G needle (group B, n=40). Women who had history of previous CS or lumber puncture due to any cause, multiparous, and need emergency CS were excluded. Data collection were done focusing incidence of PDPH, onset, site, duration and severity of the headache post operatively. Intraoperatively, difficulty in localizing the subarachnoid space and required time taken to administer spinal anesthesia were also recorded. Data analysis was done by SPSS 23.

Results: Total 80 cases of Caesarian section were included in this study. Based on the needle used during spinal anesthesia they were divided into group A and group B. 25 G and 27 G needle was used for group A and group B respectively. Age and weight distribution of pregnant mothers were almost similar in both groups and there was no statistical difference. Mean age of group A was 25.92±3.94 years and of group B was 26.56±3.83 years. Mean weight of the both groups were respectively 57.90±7.13 kg and 57.26±7.26 kg. Incidence of post-dural puncture headache (PDPH) was higher in Group A (25G) (25%) patients than Group B patients (27G) (10%) and incidence rate is significantly lower (p<0.05) in finer needle size. Irrespective of spinal needle, the overall incidence of PDPH of 80 CS patients was 14% and significantly higher incidence is noticed in-group A than group B (25% vs 10%, p<0.05). Attempt required to attain CSF is higher in group B and finer needle takes significantly more time to collect CSF (p<.001). Man duration for CSF collection was 35.08±13.43 seconds (group A) and 81.12±16.71 seconds (group B). Use of 27G spinal needle will be a good choice for reduction of PDPH.

Conclusion: This study concludes that due to less frequency of PDPH with 27G needle, it should be given preference for applying spinal anesthesia over 25G needle. Moreover, it is technically more time consuming to administer spinal anesthesia with a 27G needle than other.