Incidence of post dural puncture headache with different size quincke spinal needles in parturients undergoing caeserean section

Background: The most common, nagging and inconveniencing complication of spinal anesthesia is Post Dural Puncture Headache, which is very distressing and debilitating for the patient. Onset is usually within three days and worsens when the patient assumes erect posture. Pain is usually occipital or frontal, occasionally nuchal, radiating to neck and shoulders and dragging in nature. Headache is usually self limiting and disappears within a week. The aim of this study was to compare the incidence, intensity and severity of PDPH with different size Quincke spinal needles (25 G, 26 G and 27 G), in parturients undergoing elective Lower Segment Caesarean Section under Spinal anesthesia. Methodology: 150 patients belonging to ASA I and II in the age group 20 to 35 years, undergoing elective LSCS were included in the study. They were randomly allocated into 3 groups, depending upon the size of the spinal needle used - Group I-25G, Group II-26G, Group III-27G. The number of attempts made to locate the subarachnoid space was noted. The patients were followed up in the ward till discharge and the incidence, intensity and severity of PDPH was assessed. Results: The intensity of pain was assessed by Visual Analogue Scale in patients with symptoms suggestive of PDPH. The incidence, severity and intensity of PDPH were recorded and statistically analysed using ‘t’ test and Chi square test. From our study, we find that in young obstetric patients, the incidence of PDPH is more with large bore spinal needles and multiple dural punctures. Conclusion: We conclude from our study the incidence, intensity and severity of Post dural Puncture Headache are more with large bore Quincke spinal needles. Hence we recommend the use of fine bore needles of 27 G or less for caesarean sections to minimize the incidence of PDPH.