Post Dural Puncture Headache: A Comparative Study Of 25g And 27g Spinal Needle In Caesarean Section

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Brief description: Postdural puncture headache (PDPH) particularly following caesarean section is a well-known iatrogenic complication of spinal anesthesia mostly occurs due to loss of cerebrospinal fluid (CSF) during the procedure. To reduce the sufferings, over last three decades, spinal needles have been modified and more refined and thinner needles of25-31G have beenused. Considering limited studies in this country, the study was planned to assess comparative superiority of 27G spinal needle over 25G in Caesarean Sectionfor reduction of PDPH.The prospective, single blind, randomized study was conducted in Rangpur Medical College Hospital for 1-year period following ethical approval. Totalone hundred 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 anesthesiawith either 25G spinal needle (group A, n=50) or with 27 G needle (group B, n=50).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. :Irrespective of spinal needle, the overall incidence of PDPH of 100 CS patients was 17% and significantly higher incidence is noticed in-group A than group B (26% 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.