The Effect of Spinal Needle Type on Post-Dural Puncture Headache in Spinal Anesthesia: Prospective Randomized Study

Background: Postdural puncture headache is a headache that occurs after a dura puncture, especially in caesarean sections, and affects patient comfort and mobilization. In this study, we compared the effects of pencil-tipped spinal needles and especially curved, bilateral atraumatic spinal needles in individuals undergoing elective caesarean sections. Methods: A total of 886 patients, aged 20-50 years, who had cesarean sections with spinal anesthesia and had American Society of Anesthesiologists II and III scores, were included in the study. The patients were allocated into 3 groups using the closed envelope randomization technique: Group 1 (n = 250) received spinal insertions using 25-gauge pencil-point needles; Group 2 (n = 245) received spinal insertions using 26-gauge atraumatic needles; and Group 3 (n = 250) received spinal insertions using 27-gauge pencil-point needles. Records were kept of the quantity of spinal needle referrals, the type of treatment, the length of hospital stays, and complications. Results: In the study, 745 patients who had cesarean section operations under spinal anesthesia were further analyzed. The mean incidence of post-dural puncture headache (PDPH) was 3.2% (n = 24). The incidence of PDPH was higher in group 2 than in group 3 and group 1 (Group 1: 2.8%; Group 2: 6.8%; Group 3: 0%) (P < 0.05). Among other complications, low back, back, shoulder, and surgical complications were similar for all 3 groups. Conclusion: In caesarean section operations, pencil-point spinal needles were found to have a lower incidence of postdural puncture headache than Atraucan-cut needles, regardless of needle thickness. Keywords: Cesarean section, obstetric anesthesia, spinal anesthesia, spinal needle type