The Rate of Post-Spinal Puncture Headache in Patients Undergoing Spinal Anesthesia According to the Size of Spinal Needle (G22 versus G24): Case Reference Study

Abstract

Background: A number of disadvantages have been described in associations with spinal anesthesia such as short duration of pain relief, increased incidence of hypotension and post-spinal puncture headache (PSPH). Post-spinal puncture headache symptom has been explained by intracranial hypotension (low CSF pressure) because of CSF leak at site of puncture, causing traction on pain sensitive structures. Aim of the study: The present study was aiming at comparing the incidence rate of PSPH in relation to the gauge of used spinal needle. Patients and Method: The current observational case reference study was carried out at Al-Diwaniyah Teaching Hospital in Al-Diwaniyah Province, Iraq. The beginning of the study is dated back to the 3rd of April 2018 and the study continued till September the 15th 2019. It included 60 patients undergoing spinal anesthesia for various surgical operations. In 30 patients a spinal needle of 22 gauge was used whereas in the second group (n = 30), a spinal needle of gauge 24 was used. All patients were instructed to be nil by mouth overnight. Results: The Rate of post-spinal puncture headache (PSPH) show significant variation according to needle caliber size. Patients who experienced headache in the first group (gauge 22) were more frequent that those in group 2 (gauge 24), 22 (73.3 %) versus 8 (26.7 %) and the difference was highly significant (P < 0.001). In addition, severe headache was only seen in group 1 (gauge 22). Conclusion: The incidence and severity of post-spinal puncture headache (PSPH) is significantly related to spinal needle caliber size so that narrower needles are associated with less frequent and milder form of headache in comparison with wider bore needles