Comparing the Incidence of Postdural Puncture Headache After Spinal Anesthesia in Cesarean Sections Using 25G and 27G Quincke Needles

Abstract

Background: Postdural puncture headache (PDPH) remains a clinically relevant complication after spinal anesthesia for cesarean section, contributing to maternal discomfort, delayed recovery, and increased healthcare utilization, with needle gauge considered a modifiable procedural determinant of risk. Objective: To compare the incidence of PDPH after spinal anesthesia for elective cesarean section using 25G versus 27G Quincke spinal needles. Methods: A cross-sectional comparative observational study was conducted over four months at Tehsil Headquarter Hospital, Muridke, Pakistan, enrolling 62 ASA II parturients aged 18–40 years undergoing elective cesarean delivery under spinal anesthesia. Participants received spinal anesthesia with either a 25G (n=31) or 27G (n=31) Quincke needle under routine clinical conditions. PDPH was assessed for up to five postoperative days using International Headache Society criteria, with symptom profiling and severity assessment recorded using a visual analogue scale. Results: Overall PDPH incidence was 17.7% (11/62). PDPH occurred in 25.8% (8/31) of the 25G group and 9.7% (3/31) of the 27G group, yielding a relative risk of 2.67 (95% CI 0.78–9.12; Fisher’s exact p=0.18). Symptom patterns (e.g., neck stiffness, tinnitus, photophobia, nausea/vomiting, diplopia) were consistently more frequent with 25G, though secondary comparisons were not statistically significant. Conclusion: PDPH occurred less frequently with 27G than 25G Quincke needles in elective cesarean spinal anesthesia, indicating a clinically meaningful risk reduction, although statistical uncertainty remained due to limited event counts.