Comparative Analysis of Postoperative Complication Using 25-Gauge and 27-Gauge Spinal Needle

Abstract

Background: Post-dural puncture headache (PDPH) and related postoperative morbidity remain important limitations of spinal anesthesia for cesarean delivery, with needle gauge being a key modifiable determinant of dural trauma and cerebrospinal fluid leakage. Objective: To compare the incidence and severity of PDPH and other early postoperative complications associated with 25-gauge versus 27-gauge spinal needles in multiparous women undergoing cesarean section under spinal anesthesia. Methods: A comparative cross-sectional observational study was conducted at LIFE Hospital, enrolling 84 multiparous women (16–45 years; ASA II–III) undergoing elective cesarean section. Participants were allocated to spinal anesthesia using either a 25G or 27G needle (n=42 each). PDPH was assessed at 24, 48, and 72 hours using standardized diagnostic criteria, with pain severity graded by a visual analogue scale (VAS). Secondary outcomes included anatomical distribution of headache, intraoperative hypotension stratified by systolic blood pressure drop (20–29% vs ≥30%), vomiting, and injection-site infection. Results: PDPH within 72 hours occurred more frequently with 25G than 27G needles (42.9% vs 19.0%). Moderate-to-severe headache was observed only in the 25G group. Severe hypotension (≥30% SBP drop) was higher with 25G compared with 27G (54.8% vs 14.3%). Vomiting (16.7% vs 0%) and injection-site infection (9.5% vs 0%) occurred exclusively in the 25G group. Conclusion: In this obstetric cohort, the 27G spinal needle was associated with substantially lower PDPH burden, reduced severe hypotension, and fewer postoperative complications compared with the 25G needle, supporting preferential use of 27G needles when technically feasible