Postdural Puncture Headache in Obstetric Patients

Abstract

In response: We appreciate the letter to the editor from Drs. Chilvers and Bamber. Our study was undertaken to do a randomized comparison of five spinal needles used in a busy teaching-obstetrical hospital. Only a few studies exist in the literature that have prospectively compared five needles with a sufficient number of patients to come to a meaningful conclusion. Our intention was not only to compare the incidence of postdural puncture headache (PDPH), but also to compare the epidural blood patch (EBP) rate among the five spinal needles. Many factors influence the incidence of PDPH, including patient population, clinical setting, criteria used to define PDPH, and experience of the operator (1). Thus, the exact percentages for PDPH from one institution may not be directly compared with those from another institution. However, our results show the overall efficacy of pencil-point needles over cutting needles. We found a PDPH rate of 8.7% for the 25-gauge Quincke, which is only slightly higher than 8.5% reported by Buettner et al. (2). The EBP rate for the 25-gauge Quincke was 66% in those patients with PDPH, which was statistically higher than the noncutting needles used in our study (P = 0.000). The PDPH rate for the 25-gauge Whitacre was 0.66% in the study by Campbell et al. (3), 3.0% in the study by Buettner et al. (2) and 3.1% in our study. The PDPH rate of 0.97% reported by Chilvers and Bamber for the Whitacre needle in his letter has, to our knowledge, not appeared in a peer-reviewed journal. Although inadvertent dural puncture by the introducer may contribute to PDPH rates, introducers were used for all spinal needles in our study and we are confident that introducers did not significantly alter our PDPH or EBP rates. Manuel C. Vallejo, MD Sivam Ramanathan, MD