27-Gauge whitacre spinal needle for proctological anesthesia: Decreased incidence of post dural puncture headache

Abstract

Although spinal anesthesia is useful for proctological procedures, postdural puncture headache (PDPH) can be a serious problem. This paper describes how a 27-gauge Whitacre spinal needle may effectively reduce the postdural puncture headache. Development of headache following saddle block spinal anesthesia using 27-gauge Whitacre, 29-, 27-, or 25-gauge Quincke spinal needles in 2024 hemorrhoid surgery cases were studied. The incidence of PDPH in the 4 groups was 0.7%, 2.0%, 3.7%, and 10% respectively. The results of this study especially show 27-gauge Whitacre needle effectively reduces the incidence of PDPH compared with 27- and 25-gauge Quincke needles. Fine spinal needles like 27- or 29-gauge needles require a 22-gauge introducer to ease penetration during the procedure. But in some cases, the 29-gauge extremely fine spinal needle cannot successfully achieve dural puncture because their needle shaft is easily deflected or bent. A 27-gauge Whitacre needle did not require such delicate handling, and kept the incidence of headache low. It was concluded that a 27-gauge Whitacre needle remarkably reduces PDPH without sacrificing successful dural puncture.