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The effect of epidural needle type on postdural puncture headache: a randomized trial

[L’effet du type d’aiguille de péridurale sur les céphalées post-ponction durale : une étude randomisée]

Patricia K. Morley-Forster, MD FRCPC^*, Sudha Singh, MD FRCPC^*, Pamela Angle, MD FRCPC, Judith Littleford, MD FRCPC, Michael Currin, MD FRCPC^* and Stephen H. Halpern, MD FRCPC

^* From the Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine, University of Western Ontario, London; and the
Department of Anesthesia, Women’s Colleges and Sunnybrook Health Centre, University of Toronto, Toronto, Ontario, Canada.

Address correspondence to: Dr. Pat Morley-Forster, Department of Anesthesia and Perioperative Medicine, St. Joseph’s Health Care, 268 Grosvenor St., London, Ontario N6A 4 L6, Canada. Phone: 519-646-6000, ext. 65065; Fax: 519-646-6376; E-mail: pat.morley-forster{at}sjhc.london.on.ca

Purpose: A prospective, randomized trial in labouring parturients was undertaken to assess whether the 18G Special Sprotte^TM epidural needle is associated with a lower incidence of accidental dural puncture (ADP) in comparison with the 17G Tuohy needle. A secondary purpose was to determine if the incidence of postdural puncture headache (PDPH ) differed between groups when ADP occurred.

Methods: Following Institutional Review Board approval 1,077 parturients requesting epidural analgesia at three tertiary obstetrical units were randomized to epidural catheter insertion with a 17G Tuohy or 18G Special Sprotte^TM needle. Patients were followed for seven days by a blinded assessor to determine the occurrence of PDPH using standardized criteria. If postural headache or neck ache presented, an ADP was diagnosed even if cerebrospinal fluid (CSF) was not observed at insertion. This subgroup was followed daily to assess headache characteristics and response to blood patch.

Results: Six Tuohy group patients, and two patients in the Sprotte group were excluded. One of the six excluded in the Tuohy group had an ADP. Twenty-eight ADPs occurred, nine unrecognized by CSF visualization (1.8% Tuohy, 3.4% Sprotte, P = 0.12). The incidence of unrecognized ADPs was higher in the Sprotte group (40% Sprotte vs 20% Tuohy, P < 0.05). If ADP occurred, the incidence of PDPH was lower in the Sprotte group (100% Tuohy vs 55% Sprotte, P = 0.025). The ease of use, and user satisfaction were higher in the Tuohy group (84 ± 17.3% Tuohy vs 68.2 ± 25.3% Sprotte, P < 0.001).

Conclusion: The incidence of ADP was not reduced with the Special Sprotte^TM epidural needle in comparison with the Tuohy needle, but PDPH after ADP occurred less frequently in the Sprotte group.