COMPARISON OF POST DURAL PUNCTURE HEADACHE IN 23- AND 25-GAUGE SPINAL NEEDLE IN ELECTIVE ORTHOPEDIC SURGERIES

Background: Post-Dural Puncture Headache (PDPH) is a common complication following spinal anesthesia, primarily resulting from cerebrospinal fluid (CSF) leakage at the puncture site. It typically presents as a positional, pulsating headache, often accompanied by nausea, vomiting, and neck stiffness. Risk factors include younger age, female gender, and the use of larger, cutting-type spinal needles such as the Quincke design. PDPH can prolong hospitalization and impact postoperative recovery, highlighting the need for preventive strategies. Objective: To evaluate the incidence of PDPH in patients undergoing elective orthopedic surgeries using 23-gauge versus 25-gauge Quincke spinal needles and to identify associated risk factors. Methods: An analytical cross-sectional study was conducted on 151 patients scheduled for elective orthopedic procedures under spinal anesthesia. Participants were selected using non-probability convenience sampling. Patients were divided based on the gauge of Quincke spinal needle used (23G or 25G). Data were collected retrospectively through postoperative clinical records. Variables assessed included headache onset timing, treatment approach, and resolution. Statistical analysis was performed using SPSS version 25, with significance determined by chi-square testing (p<0.05). Results: Of the 151 patients, 91 (60.3%) were male and 60 (39.7%) were female. A total of 83 patients (55.0%) received the 23G needle and 68 (45.0%) received the 25G needle. PDPH onset was most frequent within 48–72 hours post-procedure (61 patients, 40.4%), followed by within 24 hours (41 patients, 27.2%) and between 24–48 hours (29 patients, 19.2%). Bed rest was administered to 87 patients (57.6%), while 64 (42.4%) had spontaneous resolution. Ultimately, all 151 patients (100%) reported complete headache relief. The incidence of PDPH was notably lower in the 25G group. Conclusion: This study demonstrates that the use of smaller gauge Quincke needles, specifically the 25G, is associated with a reduced incidence of PDPH in patients undergoing orthopedic spinal anesthesia. These findings support the adoption of finer needles to enhance postoperative recovery and minimize complications.