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PAKISTAN SOCIETY OF PHARMACOGNOSY & NATURAL THERAPY
PAKISTAN SOCIETY OF PHYTOPHARMACOLOGY & THERAPEUTICS
PAKISTAN SOCIETY OF PHARMACOGNOSY & NATURAL THERAPY*** PAKISTAN SOCIETY OF PHYTOPHARMACOLOGY & THERAPEUTICS
 
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FREQUENCY OF POSTDURAL PUNCTURE HEADACHE FOLLOWING SPINAL ANAESTHESIA FOR CAESAREAN SECTION: A COMPARISON BETWEEN 25-G AND 27-G PENCIL POINT SPINAL NEEDLES

Ghulam Murtaza, Akhtar Aziz Khan, Nighat Abbas and Sabahat Tariq
Department of Anaesthesialogy, Nawabshah Medical College, Sindh

 

ABSTRACT: Spinal anaesthesia is a safe technique for operative obstetrics. The relatively high incidence of postdural puncture headache in obstetric patients is considered to be a major disadvantage of the technique. Spinal needles with a pencil point tip and those of a finer gauge are known to be associated with a lower incidence of postdural puncture headache (PDPH). This study set out to determine if the fine pencil point needles were acceptably easy to use and their
effectiveness in minimizing the frequency of postdural puncture headache (PDPH) in routine clinical practice. Study included 50 women (ASA I and II) undergoing elective and emergency caesarean section were randomly allocated to receive a subarachnoid block using either a 25G or27G pencil point spinal needle, labeled as group A and group B respectively. Factors determining ease of needle use, adequacy and quality of block, frequency of postdural puncture headache, backache, and neurological sequelae were assessed. Successful intrathecal injection was achieved in all patients. Using the 27G needle, the anaesthetists failed to reach the subarachnoid space in first attempt in 5 (20%) patients, but subsequently had a successful intrathecal injection in second attempt. The failures in first attempt were attributed to excessive needle flexibility and indistinct dural click. 8% patients in Group A developed non-postdural puncture headache while in Group B, 12% patients had non-postdural
puncture headache. Backache was more common in 25G group when compared with 27G group. There was no postdural puncture headache in both the groups.
We conclude that the final choice of 25G or 27G needle is a balance between the ease of use, failure rate, level and quality of block and possibility of lower frequency of postdural puncture headache with either of them.

KEY WORDS: Spinal anaesthesia, Post dural puncture headache (PDPH), Neurology, Neurological sequelae.