The frequency of postdural puncture headache in obstetric patients: A prospective study comparing the 24-gauge versus the 22-gauge sprotte needle

Abstract

Study Objective: To compare the frequency of postdural puncture headache (PDPH) in obstetric patients when using the 24 gauge or the larger 22 gauge Sprotte needle. Design: Prospective, randomized study. Setting: Four hospitals. Patients: 375 ASA physical status I and II cesarean section and postpartum tubal ligation patients. Interventions: Obstetric patients were randomly assigned to receive spinal anesthesia via a midline dural puncture using the 24-gauge or the 22-gauge Sprotte needle. Measurements and Main Results: The rate of PDPH was determined by a postoperative visit by the anesthesiologist as well as questioning patients by telephone 1 week or more after discharge. In the 24-gauge Sprotte needle group (n = 186), 2 mild and 1 moderate PDPHs were reported, for an overall rate of 1.61%. In the 22-gauge Sprotte needle group (n = 189), 2 mild and 1 moderate PDPHs were reported, for an overall rate of 1.59%. All headaches except 1 resolved within 72 hours with conservative treatment. One patient from the 22-gauge Sprotte needle group required an epidural blood patch. There were no failed blocks in either group. Conclusions: Our results suggest that the 22-gauge Sprotte needle, when compared with the smaller 24-gauge Sprotte needle, can be used in obstetric patients without increasing the frequency of PDPH.